Use of Intrathecal Bupivacaine in Refractory Chronic Nonmalignant Pain
Bibliographic record
Abstract
OBJECTIVE: To demonstrate the efficacy and safety of the addition of bupivacaine in restoring pain control and improving quality of life and activity level in patients with chronic nonmalignant pain refractory to intrathecal opioids. DESIGN: Retrospective study. SETTING: Outpatient clinics. PATIENTS: Seventeen patients with inadequate pain relief while receiving intrathecal opioids alone. Interventions. The intrathecal opioid dose was held constant at 14.19 mg/day following the addition of bupivacaine. The initial bupivacaine dose was 2.08 mg/day and 4.83 mg/day at final follow up. OUTCOME MEASURES: Pain relief, activity, depression, and quality of life were measured by the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), EuroQol 5D (EQ-5D), and Short Form 36 (SF-36), respectively. Reduction in oral medication use, return to employment, and device-related complications were also analyzed. Outcomes were evaluated prior to pump implantation, before the addition of bupivacaine (baseline), and every 6 months thereafter. RESULTS: Seventeen patients were followed for 29.60 +/- 19.01 months. The average pain reduction measured by the VAS was 32.2%. The ODI improved 19.1%; BDI improved 17.9%; EQ-5D improved by 0.56; and the SF-36 showed statistical improvement in six of eight domains. Mean oral/transdermal opioid use reduced from 49.01 mg/day to 23.02 mg/day and oral non-opioid medications reduced from 2.2 classes to 1.0 class after the addition of bupivacaine. Two additional patients returned to work. No neurological sequelae resulted from adding bupivacaine. CONCLUSIONS: The addition of intrathecal bupivacaine restores pain control, improves activity level, quality of life, and mental health in this patient group.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".