Intrathecal drug delivery in the management of chronic pain

IF 4.7 3区医学 Q1 ANESTHESIOLOGY Best Practice & Research-Clinical Anaesthesiology Pub Date : 2023-06-01 DOI:10.1016/j.bpa.2023.02.003

Jan Van Zundert MD, PhD, FIPP (Professor) , Richard Rauck MD, FIPP (Associate Professor, Wake Forest School of Medicine)

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引用次数: 1

Abstract

Targeted intrathecal drug delivery (TIDD) has the objective of bringing the drug(s) close to the receptors influencing pain modulation, and thus reducing the dose and the side effects. Intrathecal drug delivery knew its real start with the development of permanent implantation of intrathecal and epidural catheters, combined with internal or external ports, reservoirs, and programmable pumps.

TIDD is a valuable treatment for patients with cancer suffering refractory pain. Patients suffering noncancer-related pain should only be considered for TIDD when all other options have been tested, including spinal cord stimulation.

Only two drugs are approved by the US Food and Drug Administration for TIDD administration for chronic pain: morphine and ziconotide as monotherapy. In pain management, off-label use of medication and combination therapy is often reported.

The specific action of the intrathecal drugs, the efficacy and safety, is described, as well as the modalities for trialing intrathecal drug delivery and the implantation methods.

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鞘内给药治疗慢性疼痛

靶向鞘内给药（TIDD）的目的是使药物接近影响疼痛调节的受体，从而减少剂量和副作用。鞘内给药的真正开始是鞘内和硬膜外导管的永久植入，结合内部或外部端口、储液器和可编程泵。TIDD对于患有顽固性疼痛的癌症患者是一种有价值的治疗方法。只有在测试了包括脊髓刺激在内的所有其他选择后，才应考虑对患有非癌症相关疼痛的患者进行TIDD。只有两种药物被美国食品和药物管理局批准用于慢性疼痛的TIDD给药：吗啡和齐克诺替作为单一疗法。在疼痛管理中，经常报告标签外使用药物和联合治疗。介绍了鞘内药物的具体作用、疗效和安全性，以及鞘内药物递送和植入方法的试验模式。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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