Clinical protocols for titrating constant flow implantable pumps in patients with pain or spasticity

Objectives  The objective of this paper is to report the clinical protocols that we have developed and used for titrating constant flow implantable pumps to an effective dose in de novo pain and spasticity pump patients and, thereby, highlight the similarities and differences in our techniques. As a group, we have implanted over 1600 pumps and currently manage over 800 pump patients. Materials and Methods  We used our collective experience of implanting over 1600 pumps to create protocols for performing the drug trial and the initial titration of constant flow implantable pumps in de novo patients. Results  In creating our protocols, we found that constant flow pumps can be titrated to an effective dose with two to six adjustments over a period of 1-6 months. This compares favorably to reports of programmable pumps requiring 5.3 ± 3.5 adjustments over a period of 3-6 months to reach an effective dose. Conclusions  A comparison of our protocols shows that after an initial stabilization period, dose adjustments can be made at subsequent refill, that it is not necessary to adjust the dose by prematurely emptying and filling constant flow pumps, and that it is not necessary to adjust the dose as often as has been done with programmable pumps.