Intrathecal drug therapy for long-term pain management

The use, safety, and efficacy of intrathecal medication administration with implantable pumps for cancer and chronic pain management are reviewed. Implanted intrathecal drug-delivery systems (IDDSs) are used for long-term management of persistent, severe pain despite a multimodal approach with conve...

Full description

Saved in:

Bibliographic Details
Published in:	American journal of health-system pharmacy Vol. 64; no. 23; pp. 2447 - 2461
Main Authors:	Ghafoor, Virginia L, Epshteyn, Mikhail, Carlson, Gary H, Terhaar, Donald M, Charry, Orlando, Phelps, Pamela K
Format:	Journal Article
Language:	English
Published:	England American Society of Health-System Pharmacists 01-12-2007 Oxford University Press
Subjects:	Analgesics, Opioid - administration & dosage Analgesics, Opioid - pharmacology Anesthesia, Local - standards Care and treatment Chronic Disease Drug Compounding - standards Drug Delivery Systems - standards Health aspects Humans Infusion Pumps, Implantable - standards Injections, Spinal Injections, Spinal - standards Methods Neoplasms - physiopathology Pain Pain, Intractable - drug therapy Pain, Intractable - etiology Palliative Care - standards Pharmacists Practice Guidelines as Topic Professional Role United States
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	The use, safety, and efficacy of intrathecal medication administration with implantable pumps for cancer and chronic pain management are reviewed. Implanted intrathecal drug-delivery systems (IDDSs) are used for long-term management of persistent, severe pain despite a multimodal approach with conventional pain treatment options. Currently, consensus papers published in the literature are used as guidelines for determining patient selection and medication administration, because there is a lack of supporting evidence from randomized, controlled, clinical trials. Pharmacists have a critical role in the safe use of intrathecal medication. Most of the medication concentrations and combinations administered through IDDSs are not commercially available and therefore must be compounded in a pharmacy. Medications commonly administered through IDDSs include opioids, local anesthetics, clonidine, baclofen, and ziconotide. It is important for pharmacists who prepare products for IDDSs to understand the pharmacology, adverse effects, and concentration limitations of each medication in order to prevent adverse events related to postoperative subarachnoid hemorrhage, infection, catheter-tip inflammatory masses, withdrawal, and overdose. Pharmacists play an important role in maintaining quality assurance of intrathecal drug use, including the use of standard procedures for ordering and compounding medications, documentation of patient education, and monitoring of patient outcomes. The use of long-term intrathecal drug delivery for the treatment of intractable pain or intolerable medication adverse effects has expanded to include the treatment of patients with chronic or cancer-related pain. Important considerations for the use of intrathecal drug therapy include the appropriate selection of patients, delivery systems, and medications, as well as potential complications of therapy and quality-assurance measures necessary to ensure patient safety.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-3 ObjectType-Review-1
ISSN:	1079-2082 1535-2900
DOI:	10.2146/ajhp060204