Intrathecal analgesia offers proven benefits over oral analgesics for the treatment of patients with chronic intractable pain. Intrathecal (IT) therapy delivers analgesic medication directly to the site of action of the dorsal horn of the spinal cord, thereby bypassing first-pass metabolism and the blood-brain barrier. the advantages of IT drug delivery may be relevant given the opioid abuse epidemic in the US, which has led to an excessive number of deaths (33,091 opioid-related overdose deaths in 2015). Intrathecal drug delivery system (IDDS) is a targeted therapy system for treating pain and muscle spasm and is recommended for the treatment of chronic non-malignant pain which does not respond to optimal medical management and also for intractable cancer pain and for spasticity. Patients with cancer pain receiving orally opioids and adjuvant drugs may experience adequate pain control in 80%-90% of cases. In the rest, 10–20% of the cases some form of invasive therapies will be needed.
The implantable pump is an effective treatment in order to control stable pain. the main indications, pre-implantation trials, the licensing of drugs for intrathecal use and the adverse effects and benefits of this therapy will be discussed. Based on the available evidence, morphine and ziconotide are recommended as firstline IT monotherapy for cancer-related and non-cancer-related pain.
The trialing for IT drug delivery systems remains an area of continued controversy. Considering the use of invasive devices we must fully aware of all the potential complications of the procedure, the device and the drugs used. the advantages of IDDS are: a) long term of analgesia b) decrease in opioid consumption and c) decrease in adverse events.
Deer T, et al. Intrathecal therapy for chronic pain: a review of morphine and ziconotide as firstline options. Pain Med 2018.
Sayed D, et al. Retrospective Analysis of Intrathecal Drug Delivery: Outcomes, Efficacy, and Risk for Cancer-Related Pain at a High Volume Academic Medical Center. Neuromodulation 2018.
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