Psychological and addiction issues in intraspinal therapy

There is a growing need and concern to identify appropriate therapeutic approaches to the pain patient demonstrating behaviors suggestive of “addiction.” A proper and common understanding of terms, definitions, and how these behaviors influence pain perception and therapy is gradually evolving. Intraspinal therapy may have a unique role in the treatment algorithm as it often eliminates the cues, ie, access to pain pills, that may trigger addictive behavior. Although possible, it is also much more difficult to abuse or divert opioids delivered by a drug administration system. Whether or not infusing opioids into the spine is likely to activate the “addictive process” and what patients are best suited for this therapy remain unclear. This paper presents some considerations and suggestions along with one possible approach to pre-implant trialing.