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Intrathecal Drug Delivery: Indications, Risks, and Complications

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Academic Pain Medicine

Abstract

Intrathecal drug delivery (IDD) is an effective means to treat refractory pain of malignant and nonmalignant origin. In 2017, Polyanalgesic Consensus Conference guidelines were published to provide the physician with best practices to identify patients, stratify risks, and initiate and maintain therapy. The successful use of IDD resides in the knowledge and ability of a physician to diagnose the underlying disease, stratify risks, initiate timely therapy, and identify and manage complications appropriately.

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References

  1. Wang J, Nauss L, Thomas J. Pain relief by intrathecally applied morphine in man. Anesthesiology. 1979;50(2):149–51.

    Article  CAS  Google Scholar 

  2. Deer T, Winkelmuller W, Erdine S, Bedder M, Burchiel K. Intrathecal therapy for cancer and nonmalignant pain: patient selection and patient management. Neuromodulation. 1999;2(2):55–66.

    Article  CAS  Google Scholar 

  3. Krames E, Poree L, Deer T, Levy R. Implementing SAFE principles for the development of pain medicine therapeutic algorithms that include neuromodulation techniques. Neuromodulation. 2009;12(2):104–13.

    Article  Google Scholar 

  4. Deer T, Prager J, Levy R, Rathmell J, Buchser E, Burton A, Caraway D, Cousins M, De Andres J, Diwan S, Erdek M, Grisby E, Huntoon M, Jacobs M, Kim P, Kumar K, Leong M, Liem L, McDowell G, Panchal S, Rauk R, Saulino M, Sitzman T, Staats P, Stanton-Hicks M, Stearns L, Wallace M, Willis KD, Witt W, Taksh T, Mekhail N. Polyanalgesic consensus conference 2012: Polyanalgesic consensus conference −2012: recommendations for the management of pain by IT (intraspinal) drug delivery: report of an interdisciplinary expert panel. Neuromodulation. 2012;15:436–66.

    Article  Google Scholar 

  5. Hayek S, Deer T, Pope J, Panchal S, Patel V. Intrathecal therapy for cancer and non-cancer pain. Pain Physician. 2011;14:219–48.

    Article  Google Scholar 

  6. Deer T, Caraway D, Wallace M. A definition of refractory pain to help determine suitability for device implantation. Neuromodulation. 2014;17:711–5.

    Article  Google Scholar 

  7. Smyth C, Ahmadzai N, Wentzell J, Pardoe A, Tse A, Nguyen T, Goddard Y, Nair S, Poulin P, Skidmore B, Ansari M. Intrathecal analgesia for chronic refractory pain: current and future prospects. Drugs. 2015;75:1957–80.

    Article  CAS  Google Scholar 

  8. Deer T, Smith H, Cousins M, Doleys D, Levy R, Rathmell J, Staats P, Wallace M, Webster L. Consensus guidelines for the selection and implantation of patients with noncancer pain for intrathecal drug delivery. Pain Physician. 2010;13:E175–213.

    Article  Google Scholar 

  9. Dougherty P, Staats P. Intrathecal drug delivery for chronic pain. Anesthesiology. 1999;91:1891–918.

    Article  CAS  Google Scholar 

  10. Krames E, Buchser E, Hassenbusch S, Levy R. Future trends in the development of local drug delivery systems: intraspinal, intracerebral and intraparenchymal therapies. Neuromodulation. 1999;2(2):133–48.

    Article  CAS  Google Scholar 

  11. Pope J, Deer T, Bruel B, Falowski S. Clinical uses of intrathecal therapy and its placement in the pain care algorithm. Pain Pract. 2016;16(8):1092–196.

    Article  Google Scholar 

  12. Deer T, Pope J. Factors to consider in the choice of intrathecal drug in the treatment of neuropathic pain. Expert Rev Clin Pharmacol. 2015;8(5):507–10.

    Article  CAS  Google Scholar 

  13. Deer T, Smith H, Burton A, Pope J, Doleys D, Levy R, Staats P, Wallace M, Webster L, Rauck R, Cousins M. Comprehensive consensus based guidelines on intrathecal drug delivery systems in the treatment of pain caused by cancer pain. Pain Physician. 2011;14:E283–312.

    Article  Google Scholar 

  14. Deer TR, Pope JE, Hayek S, et al. The polyanalgesic consensus conference (PACC): recommendations on intrathecal drug infusion systems best practices and guidelines. Neuromodulation. 2017;20(2):96–132.

    Article  Google Scholar 

  15. Deer TR, Pope JE, Hayek S, et al. The polyanalgesic consensus conference recommendations on intrathecal drug delivery: guidance for improving safety and mitigating risks. Neuromodulation. 2017;20(2):155–76.

    Article  Google Scholar 

  16. Bruel B, Burton A. Intrathecal therapy for cancer-related pain. Pain Med. 2016;17:2404–21.

    Article  Google Scholar 

  17. Upadhay SP, Mallick PN. Intrathecal drug delivery system (IDDS) for cancer pain management: a review and updates. Am J Hops Palliat Care. 2012;29:388–98.

    Article  Google Scholar 

  18. Narouze S, Benzon H, Provenzano D, et al. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain. Reg Anesth Pain Med. 2015;40(3):182–212.

    Article  CAS  Google Scholar 

  19. Kumar K, Nath R, Wyant GM. Treatment of chronic pain by epidural spinal cord stimulation: a 10 year experience. J Neurosurg. 1991;111:881–91.

    Google Scholar 

  20. Lang P. The treatment of chronic pain by epidural spinal cord stimulation-15 year follow up; present status. Axon. 1997;18:71–3.

    CAS  PubMed  Google Scholar 

  21. Meglio M, Coini B, Rossi GF. Spinal cord stimulation in management of chronic pain. A 9 year review. J Neurosurg. 1989;70:519–24.

    Article  CAS  Google Scholar 

  22. Follett K, Boortz-Marx R, Drake J, et al. Prevention and management of intrathecal drug delivery and spinal cord stimulation system infections. Anesthesiology. 2004;100:1582–94.

    Article  Google Scholar 

  23. Knight KH, Brand FM, Mchaourab AS, Veneziano G. Implantable intrathecal pumps for chronic pain: highlights and updates. Croat Med J. 2007;48:22–34.

    PubMed  PubMed Central  Google Scholar 

  24. Kari M, Jaycox M, Lubenow T. Complications associated with intrathecal drug delivery systems. In: Deer T, editor. Intrathecal drug delivery for pain and spasticity. Philadelphia: Saunders Elsevier; 2012. p. 102–8.

    Chapter  Google Scholar 

  25. Bhatia G, Lau ME, Gulur P, Koury KM. Intrathecal drug delivery (ITDD) systems for cancer pain. Version 3. F1000Res. 2013;2(96):1–13.

    Google Scholar 

  26. Follett K, Naumann C. A prospective study of catheter-related complications of intrathecal drug delivery systems. J Pain Symptom Manag. 2000;19:209–15.

    Article  CAS  Google Scholar 

  27. Galica R, Hayek S, Veizi IE, Lawrence M, Khalil AA, McEwan M. Sudden intrathecal drug delivery device motor stalls: a case series. Reg Anesth Pain Med. 2016;41(2):135–9.

    Article  CAS  Google Scholar 

  28. Stearns L, Boortz-Marx R, Du Pen S, Friehs G, Gordon M, Halyard M, Herbst L, Kiser J. Intrathecal drug delivery for the management of cancer pain: a multidisciplinary consensus of best clinical practices. J Support Oncol. 2005;3:399–408.

    CAS  PubMed  Google Scholar 

  29. Kim CH, Garcia R, Stover J, Ritchie K, Whealton T, Ata M. Androgen deficiency with long term intrathecal opioid administration. Pain Physician. 2014;17:E543–8.

    Article  Google Scholar 

  30. Deer T, Prager J, Levy R, Rathmell J, Buchser E, Burton A, Caraway D, Cousins M, De Andres J, Diwan S, Erdek M, Grisby E, Huntoon M, Jacobs M, Kim P, Kumar K, Leong M, Liem L, McDowell G, Panchal S, Rauk R, Saulino M, Sitzman T, Staats P, Stanton-Hicks M, Stearns L, Wallace M, Willis KD, Witt W, Taksh T, Mekhail N. Polyanalgesic consensus conference 2012: Polyanalgesic consensus conference −2012: consensus on diagnosis, detection, and treatment of catheter-tip granulomas (inflammatory masses). Neuromodulation. 2012;15:483–96.

    Article  Google Scholar 

  31. Yaksh TL, Hassenbusch S, Burchiel K, Hildebrand KR, Page LM, Coffey RJ. Inflammatory masses associated with intrathecal drug infusion: a review of preclinical evidence and human data. Pain Med. 2002;3:299–312.

    Article  Google Scholar 

  32. Jourdain V, Cantin L, Prud’Homme M, Fournier-Gosselin M. Intrathecal morphine therapy-related granulomas: faster to grow than thought. Neuromodulation. 2009;12:164–8.

    Article  Google Scholar 

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Malinowski, M.N., Bremer, N., Kim, C.H., Deer, T.R. (2019). Intrathecal Drug Delivery: Indications, Risks, and Complications. In: Khelemsky, Y., Malhotra, A., Gritsenko, K. (eds) Academic Pain Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-18005-8_22

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  • DOI: https://doi.org/10.1007/978-3-030-18005-8_22

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-18004-1

  • Online ISBN: 978-3-030-18005-8

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