Intrathecal Drug Delivery for Chronic Pain

This chapter explores intrathecal drug delivery (IDD) as a treatment option for intractable pain. IDD can provide pain relief when systemic medications, surgeries, interventional procedures, and neurostimulation implants have failed. It is the only practical method to deliver long-term opioids and opioid-local anesthetic admixtures to the spinal cord for pain relief and may provide effective opioid analgesia without contributing to the ongoing U.S. opioid crisis. The history and benefits of IDD, patient selection, trialing, and surgical implant, as well as potential complications are discussed. The chapter outlines commonly used intrathecal pain medications and explains FDA labeling and the use of on-label and off-label drugs in pain pumps as well as the differences between pharmaceutically manufactured and sterilely compounded pump medications. Also provided is a brief summary of the evidence basis of IDD and the impact of the Polyanalgesia Consensus Conference (PACC) on practitioners. The chapter serves as a comprehensive resource for understanding and utilizing IDD for the management of intractable pain.