Intrathecal drug delivery for neuropathic pain
Intrathecal pumps may be used to deliver medication directly to the intrathecal space with immediate access to the spinal cord and via the cerebrospinal circulation to the brain. Typically opioids or a combination of opioids and local anesthetic are placed in a programmable reservoir located in the lower abdominal wall, where it connects to a catheter anchored in the intrathecal space. Baclofen is sometimes used for spasticity, clonidine can be used as an adjunct, and ziconotide is a nonopioid option. This method of delivery is much more efficient than the oral route, allowing for approximately 1/300th of the amount of morphine to be given and reducing associated side effects. It has been used in multiple types of pain complaints, including postlaminectomy pain syndrome, multiple sclerosis, and CRPS, as well as nonneuropathic conditions like cancer or chronic pancreatitis. Long-term pain reduction is often modest.