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Updated: Sep 15, 2025

Intrathecal Delivery of Antisense Oligonucleotides in the Rat Central Nervous System

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Pocket Fills for Intrathecal Pump Delivery Systems: A Narrative Review.

Dylan W Banks¹, David S Jevotovsky¹, Whitman Oehlermarx¹

¹Department of Physical Medicine and Rehabilitation, New York University, New York, NY, USA.

Journal of Pain Research

|July 15, 2025

Summary

Pocket fills, a complication of intrathecal drug delivery systems (IDDS), occur when medication is injected into tissue instead of the pump reservoir. This review highlights risks, prevention strategies like imaging guidance, and future research needs for patient safety.

Keywords:

chronic pain intrathecal pump pocket fill safety

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Area of Science:

Neurology
Pain Management
Medical Devices

Background:

Intrathecal drug delivery systems (IDDS) are increasingly used for refractory chronic pain.
IDDS offer targeted medication delivery, maximizing benefits and minimizing systemic side effects.
Patient safety necessitates understanding potential IDDS complications.

Purpose of the Study:

To review pocket fills, a complication of IDDS pump refills.
To discuss the anatomy of intrathecal pump placement, risk factors, and prevention.
To provide recommendations for managing pocket fill events.

Main Methods:

This narrative review examines existing literature on IDDS and pocket fills.
Key preventative techniques such as firm pressure and imaging guidance are highlighted.
Post-procedure monitoring and device interrogation are discussed.

Main Results:

Pocket fills, where medication is injected into subcutaneous tissue instead of the pump reservoir, are suspected to be underreported.
Limited research exists on pocket fills, despite significant patient safety risks.
Preventative strategies include applying firm pressure, using imaging guidance, and post-procedure monitoring.

Conclusions:

Pocket fills pose a serious risk in IDDS management.
Tailoring preventative strategies to available resources and patient needs is advised.
Future initiatives should focus on standardized protocols, training, and research into imaging guidance and early detection technologies.