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Review
. 2014 Nov 6:7:615-26.
doi: 10.2147/JPR.S37591. eCollection 2014.

Current perspectives on intrathecal drug delivery

Michael M Bottros  1 , Paul J Christo  2
Affiliations
Review

Current perspectives on intrathecal drug delivery

Michael M Bottros et al. J Pain Res. .

Abstract

Advances in intrathecal analgesia and intrathecal drug delivery systems have allowed for a range of medications to be used in the control of pain and spasticity. This technique allows for reduced medication doses that can decrease the side effects typically associated with oral or parenteral drug delivery. Recent expert panel consensus guidelines have provided care paths in the treatment of nociceptive, neuropathic, and mixed pain syndromes. While the data for pain relief, adverse effect reduction, and cost-effectiveness with cancer pain control are compelling, the evidence is less clear for noncancer pain, other than spasticity. Physicians should be aware of mechanical, pharmacological, surgical, and patient-specific complications, including possible granuloma formation. Newer intrathecal drug delivery systems may allow for better safety and quality of life outcomes.

Keywords: drug delivery systems; intrathecal analgesia; pain control.

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Figures

Figure 1
Figure 1
Codman 3000 intrathecal pump with progressively increasing reservoir sizes. Courtesy of Codman Neuro.
Figure 2
Figure 2
Medtronic SynchroMed II intrathecal pump, programmer, and patient therapy manager. Reprinted with the permission of Medtronic, Inc. © 2012.
Figure 3
Figure 3
Prometra intrathecal pump and programmer. Images courtesy of Flowonix Medical Inc.
Figure 4
Figure 4
Patient in the lateral decubitus position for intrathecal drug delivery system implantation. The blue surgical mark indicates anticipated lumbar midline incision for intrathecal catheter placement. Photograph courtesy of MMB.
Figure 5
Figure 5
Patient in the lateral decubitus position for implantation of intrathecal drug delivery system. The blue surgical mark indicates anticipated incision in the left lower quadrant for the pump reservoir pocket. Note the importance of cushioning in this position to avoid complications associated with intraoperative nerve compression injuries. Photograph courtesy of MMB.
Figure 6
Figure 6
Ultrasound of intrathecal pump. *Indicates the reservoir fill port. Photograph courtesy of MMB.
See this image and copyright information in PMC

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