Intrathecal Drug Delivery Systems

Intrathecal drug delivery (ITDD), while initially intended for terminal oncology patients suffering from cancer pain, is currently widely used for chronic nonmalignant pain states. Before intrathecal drug delivery device (IDDD) implantation, patients with nonmalignant chronic pain must be screened for psychologic, behavioral, and medical etiologies for their pain, in addition to having a documented failure of maximal medical therapy and a successful intrathecal drug trial. Classes of drugs used for intrathecal therapy include opioids, local anesthetics, adrenergic agonists, and NMDA receptor agonists. Drugs currently approved by the FDA for ITDD are morphine, ziconotide, and baclofen. Complications of IDDD implantation are surgical (bleeding, infection, CSF leak, nerve injury), mechanical (due to catheter kink, shear, or disconnection), pharmacologic (overdose, incorrect pump settings, contaminated drugs), or medical (hypogonadotropic hypogonadism).