Intrathecal Drug Delivery for Pain
Cerebrospinal Fluid and Subarachnoid Space
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This chapter discusses the important role of intrathecal drug delivery for the treatment of chronic cancer and non-cancer pain. Specific diagnostic considerations and the role of an intrathecal trial for appropriate patient selection are discussed in depth. There are presently only two intrathecal agents approved for use by the FDA in chronic pain therapy, including morphine (an opioid), and ziconitide (a non-opioid calcium channel antagonist). Current recommendations, supporting evidence, and safety profiles of both FDA approved and off-label intrathecal medications for pain control are reviewed. The roles of combination intrathecal therapy and dual modality therapy in conjunction with spinal cord stimulation are also briefly discussed. Finally, the process of surgical implantation, commonly used drug delivery systems, and associated post-implant and pharmacologic complications are described in detail.
Elsevier Science & Technology
Cancer pain, Chronic pain, Intrathecal drug delivery, Intrathecal pump, Morphine, Neuropathic pain, Ziconotide
Harland TA, Staudt MD, Sukul VV. Intrathecal drug delivery for pain. In: Tubbs RS, Iwanaga J, Rizk EB, D’Antoni AV, Dumont AS, editors. Cerebrospinal fluid and subarachnoid space: volume 2 : pathology and disorders Academic Press; 2023. doi: 10.1016/C2019-0-00083-0