Future directions in the management of pain by intraspinal drug delivery.
Management of pain by intraspinal delivery of drugs enables physicians to target specific sites of action. While this novel approach is gaining increasing use, well-designed studies are needed. A major limitation is the lack of published information on existing drugs used for intrathecal delivery. (The strengths and weaknesses of this information are reviewed in the accompanying literature review article.) Promising agents such as bupivacaine, hydromorphone, and morphine/clonidine combinations warrant further research in large prospective (ideally randomized and double-blind) clinical safety and efficacy studies. These studies may provide data for pain management guidelines, such as those included in the preceding paper. Research must also address issues of formulation, chemical stability/compatibility, pharmacokinetics, and toxicology during clinical development and drug approval. Finally, more basic studies and early phase trials of other potential agents for intrathecal pain management (e.g., gabapentin) are needed.
Bennett
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G
Department of Neurology, MCP Hahnemann University, Philadelphia, PA, USA.
Deer
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Du Pen
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Rauck
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Yaksh
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Hassenbusch
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D000700:Analgesics / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D007278:Injections, Spinal; D010146:Pain / Q000188:drug therapy*
D000700:Analgesics