TY - JOUR
T1 - Neuraxial medication delivery
T2 - The development and maturity of a concept for treating chronic pain of spinal origin
AU - Prager, Joshua P.
AU - Straus, Barry
AU - Saal, Joel
AU - Slosar, Paul
AU - Turk, Dennis
AU - Wetzel, F. Todd
AU - Andersson, Gunnar B.J.
AU - Weinstein, James Neil
PY - 2002/11/15
Y1 - 2002/11/15
N2 - Study Design. A literature review and synthesis were performed. Objective. To summarize the history, use, and innovation related to neuraxial drug delivery for the treatment of intractable back pain. Summary of Background Data. The discovery of opiold receptors in the early 1970s provided a rational basis for the delivery of opioid drugs intraspinally. Epidural or intrathecal infusions deliver drugs directly to opioid receptors, limit systemic exposure, and by decreasing the opioid dosage required for pain relief, generally reduce side effects. The benefits of short-term spinal analgesia led to investigation of longer-term continuous subarachnoid opioid infusions for the management of both cancer pain and noncancer pain, such as that of spinal origin. Methods. Results. Unique features of this article include an updated pain continuum, updated indications for intrathecal therapy, a detailed comparison of trial techniques, a detailed comparison of the advantages of different types of pumps, a synopsis of troubleshooting for inadequate efficacy, and an updated statement regarding intrathecal pumps and radiologic procedures, including MRI scanning. Some challenges remain. Large-scale well-controlled studies could answer some perplexing questions regarding efficacy in patients with noncancer or neuropathic pain. Patient selection criteria undoubtedly will be refined and validated as more patients are treated. In addition, further investigation of specifically targeted medications or drug combinations for intraspinal use could increase efficacy, reduce side effects, and expand indications. Conclusions. Intraspinal medication delivery has become an effective technique for control of intractable pain in appropriately selected patients seen by spine surgeons.
AB - Study Design. A literature review and synthesis were performed. Objective. To summarize the history, use, and innovation related to neuraxial drug delivery for the treatment of intractable back pain. Summary of Background Data. The discovery of opiold receptors in the early 1970s provided a rational basis for the delivery of opioid drugs intraspinally. Epidural or intrathecal infusions deliver drugs directly to opioid receptors, limit systemic exposure, and by decreasing the opioid dosage required for pain relief, generally reduce side effects. The benefits of short-term spinal analgesia led to investigation of longer-term continuous subarachnoid opioid infusions for the management of both cancer pain and noncancer pain, such as that of spinal origin. Methods. Results. Unique features of this article include an updated pain continuum, updated indications for intrathecal therapy, a detailed comparison of trial techniques, a detailed comparison of the advantages of different types of pumps, a synopsis of troubleshooting for inadequate efficacy, and an updated statement regarding intrathecal pumps and radiologic procedures, including MRI scanning. Some challenges remain. Large-scale well-controlled studies could answer some perplexing questions regarding efficacy in patients with noncancer or neuropathic pain. Patient selection criteria undoubtedly will be refined and validated as more patients are treated. In addition, further investigation of specifically targeted medications or drug combinations for intraspinal use could increase efficacy, reduce side effects, and expand indications. Conclusions. Intraspinal medication delivery has become an effective technique for control of intractable pain in appropriately selected patients seen by spine surgeons.
KW - Cancer pain
KW - Epidural injection
KW - Failed back surgery syndrome
KW - Infusion pump
KW - Intraspinal injections
KW - Intrathecal injection
KW - Neuraxial medications
KW - Nonmalignant pain
KW - Opioids
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U2 - 10.1097/00007632-200211150-00037
DO - 10.1097/00007632-200211150-00037
M3 - Article
C2 - 12435999
AN - SCOPUS:0037112227
SN - 0362-2436
VL - 27
SP - 2593
EP - 2606
JO - Spine
JF - Spine
IS - 22
ER -