Sufentanil versus Fentanyl: Efficacy and Patient Satisfaction with Intrathecal Pain Management Eric A. Seemann, PhD*, K. Dean Willis, MD † , Marie L. Mueller, BA*, David D. Stephenson, BS*, Christina Kay Harden, BA*, James Michael George, PsyD † , Leah A. Pinkerton, MA, MSL, RN † , Megan R. White, BA* Objectives: This study compared fentanyl vs. sufentanil in intrathecal pain pumps. H1: both reduce patient subjective pain ratings. H2: sufentanil is more effective than fentanyl. H3: overall satisfaction with pain control is greater with sufentanil. Materials/Method: This is an archival study of patients in tertiary pain management (N = 97, mean age = 58.77, standard deviation = 14.88). Pain was measured using the subjective units of discomfort scale. Satisfaction with pain control/relief was measured by asking patients each visit if they are satisfied with pain management and is recorded in a “yes”/ “no” manner. Pain ratings were analyzed with repeated measures analysis of variance and satisfaction was analyzed with chi square. Results/Discussion: Sufentanil was found to be marginally more effective, but both medications controlled a significant degree of variance in pain reduction over time. A significantly greater number of patients maintained on sufentanil were satisfied with care than patients on fentanyl. Keywords: Fentanyl, intrathecal drug delivery system, satisfaction with care, sufentanil Conflict of Interest: The authors reported no conflicts of interest. SUFENTANIL VS. FENTANYL: EFFICACY AND PATIENT SATISFACTION WITH INTRATHECAL PAIN MANAGEMENT Intrathecal drug delivery system (IDDS) directs prescribed pain medications to the spinal cord. As an implanted device, the IDDS is considered an invasive procedure and is generally the last treatment option for patients with chronic pain. Although still somewhat con- troversial, there are many recognized advantages to IDDS treat- ment. Pain medications delivered directly to the intrathecal space are particularly effective because they do not circulate systemically to reach the cerebrospinal fluid (CSF) (1–4). Pain relief is achieved with significantly less medication when administered via IDDS. Unwanted side-effects that are common with oral medication are better controlled with IDDS (2–4), and clinical studies have docu- mented the efficacy of IDDS with many types of chronic pain, including patients with back pain, spasticity, and cancer pain. Chronic pain appears better controlled with IDDS therapy (4). Despite the advantages, there are several considerations. This is an invasive procedure that requires the implantation of a catheter, an external pump trial, and, if successful to that point, the implan- tation of the IDDS itself. Because of the invasive nature of this treat- ment, IDDS is generally only considered for patients who have exhausted other available and less invasive treatments. Despite being the last line of treatment, IDDS therapy is cost efficient. Chronic pain patient’s annual cost for conventional treatment can escalate more than $35,000 (3). An article by Kumar and colleagues reported that IDDSs were more cost effective than conventional pain therapy over a five-year period, with the initial cost of the IDDS being recovered in just over two years (4). IDDS costs (including implant and maintenance) totaled $29, 410 over five years and con- ventional treatment $38,000 (4). Morphine (morphine sulfate) was the most commonly used medication in IDDS, but technologies of both the IDDS hardware and the medications themselves have evolved considerably since IDDS first became viable in the 1970s (5). IDDSs have grown from simple, continuous flow systems to complex, programmable elec- tronic pumps with a multitude of options. Muscle relaxants, such as baclofen (Lioresal), have come to be included in the treatment of spasticity (5). The 2007 Polyanalgesic Consensus Conference (PACC) proposed an algorithm for intrathecal medication distribution (6). In their algorithm, displayed in Table 1, medication is organized in a hierar- chical order and broken down into six lines or steps. This algorithm is based on multiple factors including safety and efficacy of the drugs, reviewed literature, and expert opinion. Line one includes Address correspondence to: Eric A. Seemann, PhD, The University of Alabama in Huntsville, Huntsville, AL 35806, USA. Email: dr.seemann@gmail.com * The University of Alabama in Huntsville, Huntsville, AL, USA; and † The Alabama Pain Center, Huntsville, AL, USA For more information on author guidelines, an explanation of our peer review process, and conflict of interest informed consent policies, please go to http:// www.wiley.com/bw/submit.asp?ref=1094-7159&site=1 Research Conducted at the Alabama Pain Center, Huntsville, Alabama. Neuromodulation: Technology at the Neural Interface Received: April 1, 2011 Revised: October 13, 2011 Accepted: December 19, 2011 (onlinelibrary.wiley.com) DOI: 10.1111/j.1525-1403.2012.00432.x 1 www.neuromodulationjournal.com Neuromodulation 2012; ••: ••–•• © 2012 International Neuromodulation Society