Intrathecal Drug Therapy for Chronic Pain

Joshua P. Prager, MD, MS

Director, Center for Rehabilitation of Pain Syndromes
University of California, Los Angeles
Los Angeles, California

Intrathecal drug therapy can be an effective treatment option for patients with persistent, severe pain who do not achieve adequate analgesia from less invasive methods. The only medications that have been approved by the US Food and Drug Administration for use in intrathecal drug-delivery systems are morphine, ziconotide, and baclofen, although many others have been examined in clinical trials and widely used off-label. Physicians can refer to guidelines from a number of international symposia for recommendations on patient selection and medication administration. Candidate patients should undergo thorough medical and behavioral evaluations, and shown favorable responses in short-term trials. Potential complications of intrathecal drug therapy include inflammatory intrathecal granulomas, drug-specific adverse effects, and surgery-related infections. These risks can be mitigated by appropriate monitoring after implantation, at follow-up appointments, and following significant dosage changes. When incorporated into a comprehensive rehabilitation program, intrathecal drug therapy can relieve pain and improve long-term function in patients who have failed to respond to more conventional therapies.

References

Deer T, Krames ES, Hassenbusch S, et al. Future directions for intrathecal pain management: A review and update from the interdisciplinary Polyanalgesic Consensus Conference 2007. Neuromodulation. 2008;11(2):92-97.
Deer TR, Krames ES, Hassenbusch SJ III, et al. Polyanalgesic Consensus Conference 2007: Recommendations for the management of pain by intrathecal (intraspinal) drug delivery—Report of an interdisciplinary expert panel. Neuromodulation. 2007;10(4):300-328.
Prager JP. Neuraxial medication delivery: the development and maturity of a concept for treating chronic pain of spinal origin. Spine (Phila Pa 1976). 2002;27(22):2593-2605.

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