What are the different modes of intrathecal drug delivery? Intrathecal drugs can be delivered in one of three modes—simple continuous infusion, “flex” dosing, or continuous infusion plus patient administered boluses. Simple continuous infusion is achieved either through peristaltic delivery or administration of sequential delivery of small microboluses, depending upon the delivery system used. “Flex” dosing …
How to determine the starting dose and drug concentration when initiating intrathecal therapy? The factors to consider when initiating intrathecal therapy in a patient include patient-related factors (e.g., reactions to systemic medications, medical comorbidities) and device-related factors. Conservative dosing regimens should be used for patients with multiple and/or severe comorbidities. All drug delivery systems have …
What drugs can be given intrathecally for the treatment of pain? Medications approved in the United States for intrathecal analgesia by the US Food and Drug Administration (FDA) include two drugs: morphine and ziconotide. Baclofen is FDA approved for intrathecal therapy for spasticity. It is common clinical practice to use other unapproved medications (e.g., other …
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Which patients are potential candidates for intrathecal drug delivery? Intrathecal drug delivery is appropriate to consider in patients with severe pain refractory to systemic medications, those with intolerable side effects from systemic medications, and those who fail to respond to less invasive interventions. A lack of significant psychosocial abnormalities is also an important consideration. While …
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What are some disadvantages of intrathecal drug delivery? While intrathecal drug delivery can offer several benefits, it also has potential disadvantages and risks. Some of the disadvantages of intrathecal drug delivery include: An intrathecal drug delivery system consists of two parts, a pump, and an intrathecal catheter. The pump serves as the drug reservoir, and it …
What are the advantages of using intrathecal drug delivery compared to systemic drug administration? There are several advantages of intrathecal drug delivery over systemic medication administration. Delivery of analgesic drugs (e.g., opioids) to the intrathecal space eliminates first pass metabolism that occurs with oral administration and the larger volume of distribution that occurs with systemic …
Why is intrathecal drug delivery an attractive option for the treatment of pain? The dorsal horn of the spinal cord is a major site for pain control. Nociceptive information from the peripheral nervous system is conveyed to the central nervous system by primary afferent neurons. These are primarily myelinated and unmyelinated small-diameter neurons with cell …
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