Advances in intrathecal drug delivery.

PURPOSE OF REVIEW

Intrathecal drug delivery (IDD) continues to gain relevance as a beneficial tool for the treatment of cancer pain, spasticity, and chronic nonmalignant pain. This review includes advances in recommendations for the use of IDD for cancer pain, nonmalignant pain, and spasticity, as well as a new study of cerebrospinal fluid kinetics, updates in logistics, and recent reports of complications.

RECENT FINDINGS

Consensus-based guidelines support the use of IDD system (IDDS) in the treatment of cancer-related pain. IDDS with opioids in younger age groups may not be as successful as older patients due to tolerance issues. Research in new technologies to monitor and detect catheter breakage and disconnects is promising. There continues to be a need for more research in outcomes and new therapeutics for IDDS.

SUMMARY

IDDS continues to play an important role in the management of severe intractable pain. However, the most important areas in need of advancement, outcome studies and new therapeutics, did not have any significant breakthroughs over the past year. There is some interesting preclinical work on new therapeutics but likely the translation into clinical practice will be challenging. More work is also needed on improving technologies that will result in less catheter breaks and disconnects.