Advances in intrathecal drug delivery

Lawson, Erin F.; Wallace, Mark

doi:10.1097/aco.0b013e3283572319

Cited by 13 publications

(8 citation statements)

References 27 publications

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“…The safe and efficacious use of these medications has been outlined by an expert consensus group. [56][57][58][59][60][61][62] The Polyanalgesic Consensus Conference group has met intermittently over the past several years to establish the best practices for this therapy. 58 Table 3 lists the most commonly used medications.…”

Section: Intrathecal Delivery Of Pain Medications Ismentioning

confidence: 99%

Advanced Innovations for Pain

Lamer

Deer²,

Hayek

2016

Mayo Clinic Proceedings

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Chronic pain represents one of the most important public health problems in terms of both the number of patients afflicted and health care costs. Most patients with chronic pain are treated with medications as the mainstay of therapy, and yet most medically treated patients continue to report ongoing pain. Additionally, adverse effects from pain medications represent a major challenge for clinicians and patients. Spinal cord stimulation and intrathecal drug delivery systems are well-established techniques that have been utilized for over 25 years. Intrathecal drug delivery systems have proven efficacy for a wide variety of intractable pain conditions and fewer adverse effects than systemic medical therapy in patients with refractory cancer-related pain. Spinal cord stimulation is cost-effective and provides improved pain control compared with medical therapy in patients with a variety of refractory pain conditions including complex regional pain syndrome, painful diabetic neuropathy, and chronic radiculopathy. Patients who have intractable pain that has not responded to reasonable attempts at conservative pain care measures should be referred to a qualified interventional pain specialist to determine candidacy for the procedures discussed in this article.

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Section: Intrathecal Delivery Of Pain Medications Ismentioning

confidence: 99%

Advanced Innovations for Pain

Lamer

Deer²,

Hayek

2016

Mayo Clinic Proceedings

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“…In addition, it is necessary to understand CSF flow kinetics and drug distribution for IDD [53]. Wallace et al [54] conducted a study on steady state morphine and morphine metabolite concentrations in the CSF and peripheral circulation and the effects upon CSF chemistry (protein, glucose, white blood cells) after long-term spinal infusion.…”

Section: Drug Movement In Csfmentioning

confidence: 99%

Role of Catheter's Position for Final Results in Intrathecal Drug Delivery. Analysis Based on CSF Dynamics and Specific Drugs Profiles

et al. 2013

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Intrathecal drug delivery is an effective and safe option for the treatment of chronic pathology refractory to conventional pain therapies. Typical intrathecal administered drugs are opioids, baclofen, local anesthetics and adjuvant medications. Although knowledge about mechanisms of action of intrathecal drugs are every day more clear many doubt remain respect the correct location of intrathecal catheter in order to achieve the best therapeutic result. We analyze the factors that can affect drug distribution within the cerebrospinal fluid. Three categories of variables were identified: drug features, cerebrospinal fluid (CSF) dynamics and patients features. First category includes physicochemical properties and pharmacological features of intrathecal administered drugs with special attention to drug lipophilicity. In the second category, the variables in CSF flow, are considered that can modify the drug distribution within the CSF with special attention to the new theories of liquoral circulation. Last category try to explain inter-individual difference in baclofen response with difference that are specific for each patients such as the anatomical area to treat, patient posture or reaction to inflammatory stimulus. We conclude that a comprehensive evaluation of the patients, including imaging techniques to study the anatomy and physiology of intrathecal environment and CSF dynamics, could become essential in the future to the purpose of optimize the clinical outcome of intrathecal therapy.

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“…It is necessary to understand CSF flow kinetics and drug distribution for IDDS [2]. Wallace and Yaksh [30] conducted a study on steady-state morphine and morphine metabolite concentrations in the CSF and peripheral circulation, and the effects upon CSF chemistry (protein, glucose, and white blood cells) after long-term spinal infusion.…”

Section: Drug Delivery (Cerebrospinal Fluid/drug Flow Kinetics)mentioning

confidence: 99%

“…Recent technological advances, new therapeutic applications, the reported complications, and the costs and maintenance required for this therapy determine the need to stay up-to-date about the new recommendations that may improve the outcomes [2]. This therapy is well established in the literature, has shown efficacy, and is an important tool for the treatment of spasticity, and both cancer and nonmalignant pain [1 && ].…”

Section: Introductionmentioning

confidence: 99%