How are implantable intrathecal drug administration systems used the treatment of low back pain (LBP) and sciatica?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Continuous infusion of intrathecal medication is used for control of chronic, refractory, malignant and nonmalignant pain. [233, 234, 235, 213] In a systematic review of effectiveness and complications of programmable intrathecal opioid delivery systems for chronic noncancer pain, Turner et al found improvement in pain among patients who received a permanent intrathecal drug delivery system. [213]

A systematic review for long-term management of noncancer pain by Patel et al indicated the level of evidence for support of intrathecal infusion systems was limited. [234] However, 5 observational studies met inclusion criteria. [236, 237, 238, 239, 240] Three of the 5 observational studies showed positive outcomes for significant pain relief lasting less than and longer than 1 year in 232 patients. The most common indication for the use of intrathecal pumps is disease of the spine. [241] Common specific diseases include adhesive arachnoiditis, postlaminectomy syndrome, spinal stenosis, and intractable low back and lower extremity pain.

Evaluation of cost effectiveness in postlumbar surgery syndrome showed that intrathecal morphine delivery resulted in lower cumulative 60-month costs of $16,579 per year and $1,382 per month versus medical management at $17,037 per year or $1,420 per month. [241]

Complications include postdural puncture headache, infection, nausea, urinary retention, pruritus, catheter and pump failure, pedal edema, hormonal changes, granuloma formation, and decreased libido. [242, 243, 244, 245, 246, 247, 248] Based on Guyatt et al’s criteria, the recommendation for intrathecal infusion systems is strong with proper patient selection criteria. [232]


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