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:
- Infection risk: An infection can occur after any invasive operation. There is a slight chance of infection while using intrathecal medication delivery, either in the intrathecal space or at the location of catheter insertion. Serious infections may necessitate further care, such as antibiotics and catheter removal.
- Catheter complications: Intrathecal drug delivery catheter dislocation, kinking, or blockage may occur, causing problems with drug delivery. Complications with the catheter may need for further treatments or maybe surgery.
- Technical difficulties: Specialized knowledge and abilities are needed for the intrathecal drug delivery system implant and management procedures. This method is not taught to all healthcare providers, which may restrict its accessibility and raise the risk of problems if it is not handled or carried out correctly.
- Drug-related side effects: The drugs delivered intrathecally can have side effects, just like any medication. These side effects may include nausea, dizziness, drowsiness, constipation, respiratory depression, and allergic reactions. The risk and severity of these side effects can vary depending on the specific drug used.
- Limited drug options: Intrathecal drug delivery is primarily used for the administration of certain medications, such as opioids and certain anti-spasticity drugs. The range of available drugs for intrathecal use is limited compared to oral or systemic options. This can be a disadvantage if a patient requires a medication that is not suitable for intrathecal delivery.
- Device-related issues: The intrathecal drug delivery system typically involves the placement of a pump or reservoir device that delivers the medication. These devices require regular maintenance, including refilling the medication, monitoring battery life, and addressing any malfunctions or complications. Device-related issues can be a challenge to manage and may require additional procedures or interventions.
- The delivery of intrathecal analgesics is an invasive technique that requires surgical implantation of a drug delivery system, including an intrathecal catheter and drug reservoir/pump, that may be contraindicated in some patients based on their medical comorbidities.
- It also requires continuous follow-up because the drug reservoir will eventually empty and require refilling to prevent drug withdrawal, which may preclude use in patients who have limited access to medical care.
- The initial costs of intrathecal drug delivery are high compared to oral or parenteral analgesic administration; however, studies show cost savings over time.
An intrathecal drug delivery system consists of two parts, a pump, and an intrathecal catheter.
The pump serves as the drug reservoir, and it is implanted under the subcutaneous tissue in the abdominal area.
The second is the catheter which attaches to the pump and delivers medications directly into the intrathecal space.
Intrathecal drug delivery systems are typically used for three main purposes, which are the treatment of chronic non-malignant pain, muscle spasticity, and cancer-related pain.
This activity reviews the indications, contraindications, and technique involved in the implantation of an intrathecal drug delivery system and highlights the role of the interprofessional team in the care of patients undergoing this procedure.
Generally, catheter tip placement is at the level of the spinal cord that innervates the body region comprising the primary pain generator.
Once in the CSF, intrathecally delivered medications permeate across the pia-arachnoid and white matter of the spinal cord to access the target dorsal horn receptors and ion channels engaged in nociceptive processing and transmission.
It’s important to discuss the potential advantages and disadvantages of intrathecal drug delivery with a healthcare provider who specializes in this area.
They can assess individual circumstances, consider the risks and benefits, and provide personalized recommendations based on the patient’s condition and treatment goals.
