Intrathecal Drug Therapy for Painful Vertebral Metastases

Vertebral metastases often lead to a complex pain syndrome that consists of both nociceptive and neuropathic pain. Multimodal medical management often includes paracetamol, non-steroidal anti-inflammatory agents, bisphosphonates, opioids, antidepressants, anti-epileptics, and neuroleptics. Surgical treatment to address oncologic burden and spinal instability, radiation therapy, and vertebroplasty or kyphoplasty may be indicated for some patients. However, often times patients with advanced malignancies are not able to safely undergo surgery and have medication-refractory oncologic pain. For these patients and for patients unwilling to undergo large oncologic or spinal stabilization surgeries, intrathecal drug therapy (IDT) serves as a safe and effective adjunct in the management of cancer-related pain.