Utilisation des pompes intrathécales dans le traitement de la douleur chronique non cancéreuse

According to the latest data, 18.9% of Canadians and 15.7% of Quebecers suffer from chronic pain, which is defined as pain persisting beyond normal tissue healing time, assumed to be three months. Chronic pain may or may not originate from cancer. Chronic non-cancer pain (CNCP) includes neuropathic pain, which affects from 1.5% to 8% of the general population and is known to be the most resistant to conventional medical management.

Several treatments are available for CNCP, including the use of spinal cord stimulators (SCS) and intrathecal pumps, when conventional approaches are unsuccessful. Given that the use of these devices generates significant costs, which hinder their accessibility, and that clinical practices vary across hospital centres, the Institut national d’excellence en santé et en services sociaux (INESSS) was mandated to assess the evidence on the efficacy, safety and costs associated with this treatment, with a view to providing better clinical practice guidelines especially regarding patient selection, clinical procedures and post-implantation follow-up.

The current reports contain a systematic review of the literature on the different dimensions associated with the use of intrathecal pumps and spinal cord stimulators for the treatment of CNCP; a narrative review of the clinical indications based on Canadian and international clinical practice guidelines; and an analysis of the costs related to the use of these devices for this treatment.

The results of these two assessments served as the basis for developing an optimal use guide on neuromodulation to better support clinical practices across the province.