Amid the COVID-19 pandemic, the need to prevent the spread of disease and manage critical hospital resources has never been more critical. In a letter to the editor of Neuromodulation, Philip Kim (Center for Interventional Pain Spine, Bryn Mawr, USA) and Timothy Deer (The Spine and Nerve Center of the Virginias, Charleston, USA) stress that decision-making in intrathecal drug delivery devices can be “life-threatening” and medical judgement should be used on a case per case basis.
Through utilising multiple combinations of off-label and on-label preparations, Kim and Deer acknowledge that these intrathecal drug delivery devices are “life-changing” in providing relief for intractable pain and spasticity that is not responsive to systemic analgesics. “Holding off on these therapies and asking patients to return to oral medications alternatives including opioids can lead to concerns of opioid addiction, dependence, and diversion,” they add.
In terms of the “many” patients that receive a combination of therapies, Kim and Deer argue that sudden and severe withdrawal reactions could occur. Alluding to a specific example, they write that abrupt cessation of intrathecal baclofen can result in life-threatening multi-organ failure and death.
Treating COVID-positive or high-risk patients
The authors urge, “if possible”, to delay refill of the intrathecal drug delivery devices, as well as reprogramming for two weeks. However, if this is not possible, home visits should be considered, preferably at the end of the day to minimise exposure to staff and allow further decontamination.
Treating COVID-19 or low-risk patients
Ensuring minimal patient movement and abiding by social distancing rules during the initial assessment is the top priority, according to Kim and Deer. The patient should also be encouraged to wear a mask, while the healthcare provider should wear a mark, eyeglass protection, and a surgical gown and gloves.
If possible, N95 masks should be used, and the healthcare worker should utilise the plastic covers of the programmer, note the authors. They also allude to the routine aseptic technique, and—though acknowledging that the Center for Disease Control and Prevention (CDC) or the World Health Organisation (WHO) have not issued instructions about how to clean face masks—Kim and Deer urge workers to safely remove and dispose of gloves, masks, and material.