title: Intrathecal pain pumps: indications, patient selection, techniques, and outcomes.
abstract: Intrathecal drug delivery represents an advanced modality for refractory chronic pain patients as well as intractable spasticity. This article reviews the advantages and indications for intrathecal therapy, as well as recommendations for proper patient selection using a multidisciplinary team to provide a global assessment of the impact of chronic pain on the patient's well-being. The goals and expectations of trialing are discussed alongside advantages and disadvantages of several trialing techniques. A discussion of outcomes is presented for patients with chronic pain due to both malignant and nonmalignant causes.
authors.affiliation: Department of Pain Management, Cleveland Clinic, 9500 Euclid Avenue/C25, Cleveland, OH 44195, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Bolash
authors.affiliation: Evidence Based Pain Medicine Research, Department of Pain Management, Cleveland Clinic, 9500 Euclid Avenue/C25, Cleveland, OH 44195, USA. Electronic address: mekhain@ccf.org.
authors.forename: Nagy
authors.initials: N
authors.lastname: Mekhail
mesh_terms: D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D059350:Chronic Pain / Q000188:drug therapy; D006801:Humans; D015918:Infusion Pumps, Implantable; D060186:Infusions, Spinal / Q000379:methods*; D009020:Morphine / Q000627:therapeutic use; D009437:Neuralgia / Q000188:drug therapy; D059226:Nociceptive Pain / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy* / Q000601:surgery*; D018579:Patient Selection; D013116:Spinal Cord / Q000601:surgery*; D016896:Treatment Outcome; D020960:omega-Conotoxins / Q000627:therapeutic use
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D020960:omega-Conotoxins; D009020:Morphine; C078452:ziconotide
keywords: Chronic pain; Intractable spasticity; Intrathecal drug delivery; Intrathecal pain pumps