BACKGROUND Various methods exist for trialing patients for intrathecal drug delivery. Currently no standards exist regarding "best practices" for trialing techniques. OBJECTIVES The specific aim of the current study is to report results of patients trialed using a low-dose intrathecal morphine technique in the treatment of chronic noncancer pain. SETTING academic pain medicine practice ST...

SYSTEMIC analgesics and conservative therapies are effective in controlling chronic pain for the majority of patients. However, many other patients, such as those with advanced head and neck carcinoma and those with neuropathic pain, require more aggressive therapy to directly modulate pain transmission in the central nervous system. Reversible methods of aggressive therapy in the spinal cord i...

Targeting analgesic drugs for spinal delivery reflects the fact that while the conscious experience of pain is mediated supraspinally, input initiated by high intensity stimuli, tissue injury and/or nerve injury is encoded at the level of the spinal dorsal horn and this output informs the brain as to the peripheral environment. This encoding process is subject to strong upregulation resulting i...

Pain is prevalent in advanced malignancies; however, some patients cannot get adequate pain relief by conservative routes of analgesic administration or experience serious side effects related to high dose of opioids. For those who have exhausted multimodal conservative analgesic, intrathecal drug delivery is an alternative intervention for truly effective pain management. The objective of this...

Direct central nervous system (CNS) analgesic delivery is a useful option when more traditional means of dealing with chronic pain fail. Solutions containing local anesthetic have been effective in certain disease states, particularly in patients suffering from intractable head and neck pain. This review discusses historical aspects of CNS drug delivery and the role of intrathecal bupivacaine-c...

The aim of this principally experimental study is to understand from fluid mechanic principles why an insignificant anesthetic dose administered as a short bolus into the cerebrospinal fluid inside the subarachnoid space provides greater pain relief than a larger dose continuously injected over a longer period. The subarachnoid space is modeled as an annular gap of constant or slowly varying cr...