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Published on: April 11, 2018
Intrathecal drug therapy for long-term pain management
Virginia L Ghafoor1, Mikhail Epshteyn, Gary H Carlson
1Pain Management, Pharmacy Department, University of Minnesota Medical Center (UMMC), Minneapolis 55454, USA. vghafoo1@fairview.org
Summary
Implanted intrathecal drug-delivery systems (IDDSs) offer long-term pain management for severe chronic and cancer pain. Pharmacists are crucial for safe compounding and quality assurance of these specialized intrathecal medications.
Area of Science:
- Pain Management
- Pharmacology
- Drug Delivery Systems
Background:
- Intrathecal drug-delivery systems (IDDSs) are utilized for persistent, severe pain unresponsive to conventional treatments.
- Current guidelines rely on consensus papers due to a lack of randomized controlled trials.
Purpose of the Study:
- To review the use, safety, and efficacy of intrathecal medication administration via implantable pumps.
- To highlight the expanded application of IDDSs for chronic and cancer-related pain management.
Main Methods:
- Review of existing literature and consensus guidelines.
- Analysis of medication commonly administered via IDDSs (opioids, local anesthetics, clonidine, baclofen, ziconotide).
Main Results:
- IDDSs are effective for long-term management of intractable pain or intolerable adverse effects from conventional therapies.
- Most IDDS medications require pharmacy compounding due to non-commercial availability.
Conclusions:
- Appropriate patient selection, delivery systems, and medications are critical for successful intrathecal therapy.
- Pharmacists play a vital role in ensuring safe compounding, quality assurance, and patient monitoring for IDDSs.
- Understanding medication pharmacology and potential complications is essential to prevent adverse events.
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