Management of chronic back and leg pain by intrathecal drug delivery.
Intrathecal delivery of analgesic drugs by implantable pump systems has been recognized as a treatment option for patients with chronic pain of benign or malignant origin that is resistant to oral or parenteral medication. Patients with chronic back and leg pain (CBLP), a benign but severely disabling condition of the lumbar spine with multifactorial genesis, have been demonstrated in a number of retrospective and in some prospective clinical studies to benefit from intrathecal delivery of opioid and/or non-opioid substances, either as single drugs or in combinations. In addition, intrathecal therapy for CBLP has been proven safe and less expensive that conventional medical therapy. This chapter summarizes the clinical and experimental evidence and the personal experience of the authors with long-term intrathecal infusion therapy for CBLP. It discusses important clinical issues such as drug selection, drug combinations, and side effects and complications of intrathecal infusion. It is concluded that further clinical research is needed in order to provide stronger evidence for the usefulness of a number of drugs currently used for intrathecal therapy on a mostly empirical basis.
Rainov
N G
NG
Department of Neurosurgery, Central Clinic Augsburg, Augsburg, Germany. nikolai.rainov@medizin.uni-halle.de
Heidecke
V
V
D000700:Analgesics / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001415:Back; D002908:Chronic Disease; D006801:Humans; D015918:Infusion Pumps, Implantable; D007866:Leg; D010146:Pain / Q000188:drug therapy* / Q000473:pathology*
D000700:Analgesics; D000701:Analgesics, Opioid