Complexities in the underlying pathophysiologic mechanisms and clinical manifestations of chronic pain result in a large number of patients for whom conventional management strategies fail to produce adequate pain relief or functional gains.1,2 For some of these individuals, medications delivered directly to the intrathecal space can be a safe and effective treatment option.3,4 The US Food and Drug Administration (FDA) has approved 2 analgesics—ziconotide and morphine—for intrathecal delivery in patients with severe chronic pain.5,6 However, intrathecal therapy remains underutilized for chronic pain, in part owing to historically suboptimal outcomes stemming from poor patient selection, systemic barriers, and safety concerns (eg, opioid-induced respiratory depression).7 Available in multiple formats, this multimedia eHealth SourceTM will cover the latest published evidence and practical guidance on evaluating candidates for intrathecal drug delivery, initiating this treatment strategy using FDA-approved intrathecal analgesics, longitudinally monitoring patients with implanted pumps, and tailoring therapy based on analgesia, functional outcomes, and treatment-emergent adverse effects.
1. National Research Council. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Institute of Medicine. Washington, DC: The National Academies Press; 2011.
2. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581-624.
3. Onofrio BM, Yaksh TL, Arnold PG. Continuous low-dose intrathecal morphine administration in the treatment of chronic pain of malignant origin. Mayo Clin Proc. 1981;56(8):516-520.
4. Prager J, Deer T, Levy R, et al. Best practices for intrathecal drug delivery for pain. Neuromodulation. 2014;17(4):354-372.
5. Ver Donck A, Vranken JH, Puylaert M, et al. Intrathecal drug administration in chronic pain syndromes. Pain Pract. 2014;14(5):461-476.
6. Kim P, Grigsby E, Deer T, et al. Effectiveness and safety of intrathecal ziconotide as the first agent in pump for adult patients with severe chronic pain. Presented at the 22nd Annual Napa Pain Conference; August 27-29, 2015; Napa, CA.
7. Coffey RJ, Owens ML, Broste SK, et al. Mortality associated with implantation and management of intrathecal opioid drug infusion systems to treat noncancer pain. Anesthesiology. 2009;111(4):881-891.