Intrathecal Drug Therapy in Chronic Pain Management

Chronic pain impacts the quality of multiple functional domains, including family life, workplace performance, social interactions, and sleep patterns. The management of chronic pain continues to pose many challenges to healthcare providers. Intrathecal drug delivery systems (IDDS) provide an effective therapy for patients suffering from chronic pain intractable to medical management. to identify best practices and provide guidance to clinicians to ensure safety and optimize intrathecal drug delivery for chronic intractable pain management. This is a review article, The search was performed in MEDLINE, Embase, Pubmed and CINAHL Plus in the same date range with the following mediacl terms. Intrathecal drug (IT) delivery has many benefits compared with oral or parenteral routes for pain control. First, it allows for the use of significantly lesser doses of opioids. Second, it bypasses the first pass effect and the blood brain barrier. Third, patients typically experience fewer adverse effects (AEs) due to the decreased total dose of opioid used. However, IT therapy may be associated with complications related to many factors, including those related to the IT pump itself (e.g., mechanical failure), pump pocket fills, issues surrounding preparation of the IT medication and programming of the pump for medication release, and complications following pump implantation surgery. Optimal use of this therapy depends on a thorough understanding of intrathecal physiology and anatomy as well appreciation of physicochemical properties of administered medications and the mode of IT delivery.