Drug delivery systems.
Intrathecal drug delivery (IDD) is a proven and effective treatment alternative in carefully selected patients with chronic pain that cannot be controlled by a well-tailored drug regime and/or spinal cord stimulation (SCS), and may be specifically trialed in patients who fail to respond to SCS. While the lack of randomized controlled trials is often perceived as a limitation of IDD, many studies attest to the efficacy of this therapy, and a number are large-scale and with follow-up periods of up to five years. Good to excellent pain relief is achieved in many patients who have failed more conservative therapies, and there is often a reduced need for analgesia. The advent of patient-controlled analgesia allows flexibility of dosing according to the patient's needs. Consequently, quality of life improves in many patients and the majority express satisfaction with treatment. Some patients are able to return to work. The benefits of IDD (including a potent analgesic response with a more stable therapeutic drug level, decreased latency, increased duration of action, and decreased pharmacological complications) mean that side effects such as nausea, vomiting, sedation, and constipation are reduced. In addition, IDD demonstrates long-term cost-effectiveness when compared to conventional pain therapies, addressing a concern that affects many physicians in clinical practice today.
Erdine
Serdar
S
Department of Algology, Medical Faculty of Istanbul University, Istanbul, Turkey. algomed@superonline.com
De Andrés
José
J
D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D016503:Drug Delivery Systems / Q000379:methods / Q000592:standards / Q000639:trends*; D006801:Humans; D007278:Injections, Spinal / Q000379:methods / Q000592:standards; D010148:Intractable Pain / Q000188:drug therapy* / Q000503:physiopathology; D017060:Patient Satisfaction; D010523:Peripheral Nervous System Diseases / Q000188:drug therapy* / Q000503:physiopathology; D012646:Self Administration / Q000592:standards; D013346:Subarachnoid Space / Q000187:drug effects / Q000502:physiology; D016896:Treatment Outcome
D000700:Analgesics