Intraspinal drug delivery routes for treatment of chronic pain and spasticity

Subarachnoidal and epidural are the two most frequent routes for intraspinal drug delivery in treatment of chronic pain and spasticity. In addition, there are less frequently used intraventricular and subdural routes. In this review, basic concepts of intraspinal drug delivery using different intraspinal routes are discussed. The intrathecal administration of drugs is preferred today, mainly because of effective dosing in low volumes using portable infusion systems. Intrathecal catheters are longer lasting and have lower rates of complications than epidural; there are fewer side effects and development of tolerance in patients with chronic pain is reduced when the intrathecal route is used. Today, for long-term pain management in patients with benign chronic pain and in those cancer patients with longer life expectancy, the intrathecal route is preferred.