Special Patient Populations
Description
As the use of intrathecal therapy has become more common in our armamentarium for the treatment of chronic pain, the indications for implantation have expanded to include new conditions and patient populations; however, the literature regarding these developing indications is sparse, consisting primarily of case reports and case series. As such, robust, long-term data are lacking. In this chapter, we review the management of intrathecal drug therapy in specific patient populations that require further attention. This includes patients with atypical pain syndromes, children, immunocompromised patients, and patients on blood thinning agents. In addition, we discuss treatment options for individuals with other implantable devices. Finally, we examine the treatment algorithm in the setting of cerebrospinal fluid leaks. Of note, while there are currently only three intrathecal agents approved for use by the Food and Drug Administration, morphine (an opioid), ziconotide (a non-opioid calcium channel antagonist), and baclofen (a GABAB receptor agonist), this chapter also reports on the use of investigational intrathecal therapies that are considered off-label.
