Intrathecal Drug Delivery Systems for Chronic Non-cancer Pain

Abstract

Chronic non-cancer pain (CNCP) remains a significant health-care problem challenging to treat. A portion of the chronic non-cancer pain patients do not respond to conventional pain treatments and require interventional approaches for symptoms management. Over the last three decades, intrathecal drug delivery (IDD) has been established as an effective and safe modality for the treatment of intractable chronic non-cancer pain, spasticity, and cancer pain. The roots of this treatment lie in the basic understanding of intrathecal drug administration for operative anesthesia. While early treatment was primarily based on expert opinion, it is now a well-accepted evidence-based treatment for severe CNCP. Several studies conducted over the last two decades have consistently demonstrated improvement in pain intensity scores with this modality. However, the strength of evidence is still weak, and more work needs to be done to elucidate effectiveness and evaluate newer pharmacological agents. In this chapter we discuss the historical significance, important clinical considerations and outcomes of IDD for CNCP.