BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ISOMED

    MDR report key: 3083226 · Received April 29, 2013

    Report

    Report Number
    3007566237-2013-01464
    Event Type
    Injury
    Date Received
    April 29, 2013
    Date of Event
    December 1, 2006
    Report Date
    April 29, 2013
    Manufacturer
    MEDTRONIC NEUROMODULATION
    Product Code
    LKK
    PMA / PMN Number
    P990034
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AS
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4).

    Description of Event or Problem · 1

    HAYES, C., JORDAN, M. S., HODSON, F. J., RITCHARD, L. CEASING INTRATHECAL THERAPY IN CHRONIC NON-CANCER PAIN: AN INVITATION TO SHIFT FROM BIOMEDICAL FOCUS TO ACTIVE MANAGEMENT. PLOS ONE. 2012;7(11). DOI: 10.1371/JOURNAL.PONE.0049124. SUMMARY: THIS CASE SERIES REPORTS THE CHANGING USE OF IT IMPLANTED DRUG DELIVERY SYSTEMS (IDDSS) FOR CHRONIC NON-CANCER PAIN OVER 13 YEARS. INITIALLY IT THERAPY WAS USED SELECTIVELY FOLLOWING MULTIDISCIPLINARY ASSESSMENT AND DOUBLE BLIND IT TRIAL. TYPICAL THERAPY COMBINED OPIOID WITH CLONIDINE. MULTIDIMENSIONAL MANAGEMENT WAS OFFERED. TREATMENT STRATEGY CHANGED IN 2003 DUE TO HIPS EXPERIENCE OF LIMITED THERAPEUTIC GAINS AND EQUIVOCAL SUPPORT FOR IT THERAPY IN THE LITERATURE. SUBSEQUENTLY, IT THERAPY WAS NO LONGER INITIATED FOR NON-CANCER PAIN AND THOSE ON ESTABLISHED REGIMES WERE ENCOURAGED TO SHIFT TO ORAL/TRANSDERMAL OPIOIDS WITH GREATER EMPHASIS ON ACTIVE MANAGEMENT. PATIENT EDUCATION AND CONSULTATION WERE KEY ELEMENTS. WHERE IT CESSATION WAS ELECTIVE GRADUAL DOSE REDUCTION COMMENCED AS AN OUTPATIENT. IN ELECTIVE AND URGENT CASES KETAMINE INFUSION AND ORAL CLONIDINE WERE USED DURING HOSPITAL ADMISSIONS TO COVER THE SWITCH TO ORAL/TRANSDERMAL OPIOIDS. OVER THE STUDY PERIOD TRANSITION OCCURRED TO A BROADER MANAGEMENT FRAMEWORK IN WHICH IT THERAPY FOR CHRONIC NON-CANCER PAIN WAS NO LONGER SUPPORTED BY HIPS. 25 PATIENTS WERE MANAGED USING IDDSS; 8 IMPLANTED BY HIPS AND 17 BY OTHER TEAMS. DOSE ESCALATION AND ADVERSE EFFECTS WERE COMMON; 24 OF 25 PATIENTS CEASED IT THERAPY; 7 (29%) WITH URGENT IDDS RELATED COMPLICATIONS, 16 (67%) ELECTIVELY AND 1 DUE TO AN UNRELATED DEATH. THE REMAINING PATIENT RETURNED TO HER ORIGINAL TEAM TO CONTINUE IT THERAPY. ONE POST-EXPLANTATION PATIENT TRANSFERRED TO ANOTHER TEAM TO RECOMMENCE IT THERAPY. THE REMAINDER WERE SUCCESSFULLY MAINTAINED ON ORAL/TRANSDERMAL OPIOIDS COMBINED WITH ACTIVE MANAGEMENT. REPORTED EVENT: PLEASE NOTE-THIS PATIENT WAS PREVIOUSLY REPORTED WITH LIMITED INFORMATION UNDER MANUFACTURER REPORT 3007566237-2013-00338. THROUGH FOLLOW-UP WITH THE CORRESPONDING AUTHOR, THE PATIENT WAS IDENTIFIED. THE PATIENT, (B)(6), WAS ADMITTED TO THE ICU IN (B)(6) 2006 DUE TO A LIFE-THREATENING OVERDOSE RESULTING FROM A PUMP SEPTUM FAILURE. THE PUMP WAS REMOVED IM (B)(6) 2007 AND RETURNED TO THE MANUFACTURER FOR TESTING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    185786 ISOMED PUMP, INFUSION, IMPLANTED, PROGRAMMABLE LKK MEDTRONIC NEUROMODULATION NEU_UNKNOWN_PUMP

    Patients

    Seq Age Sex Outcome Treatment
    1 Life Threatening| R