[Chronic intrathecal drug administration for the control of intractable pain].
Intrathecal drug administration for the control of intractable pain has been practiced over many years in various countries; however, because of government regulation, no drugs except baclofen are approved for chronic intrathecal use in Japan. In this review, I have summarized the current international situation regarding the chronic intrathecal administration of various types of drugs for the control of intractable cancer and non-cancer pain. Morphine is the gold standard for this purpose, but its combination with local anesthetics or clonidine may be essential. Although this combination has presented strong evidence of cancer pain control, it shows weak evidence of non-malignant chronic pain control, probably because of the complex pathophysiology of the latter condition. A few new drugs such as ziconotide and gabapentin have been investigated, but the effective control of neuropathic pain, including complex regional pain syndrome, still appears difficult. Contrary to the general belief, intrathecal drug administration via an implantable pump is cost-effective, and I believe that this intrathecal drug delivery system should be used more extensively used for pain management in Japan.
Taira
Takaomi
T
Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
D000588:Amines / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001418:Baclofen / Q000008:administration & dosage; D002121:Calcium Channel Blockers / Q000008:administration & dosage; D003000:Clonidine / Q000008:administration & dosage; D003509:Cyclohexanecarboxylic Acids / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D018755:GABA Agonists / Q000008:administration & dosage; D000077206:Gabapentin; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal; D009020:Morphine / Q000008:administration & dosage; D009369:Neoplasms / Q000150:complications; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage; D020960:omega-Conotoxins / Q000008:administration & dosage
D000588:Amines; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D002121:Calcium Channel Blockers; D003509:Cyclohexanecarboxylic Acids; D018755:GABA Agonists; D020960:omega-Conotoxins; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D009020:Morphine; C078452:ziconotide; D001418:Baclofen; D003000:Clonidine