Intrathecal therapy offers an invasive alternative for the long-term management of select patients with intractable pain associated with various disease states, including those of noncancer origin. It is commonly accepted that proper patient selection is essential to optimizing treatment outcomes, yet the practice of candidate selection for device implantation varies widely. A multifaceted appr...

Cancer pain is prevalent and often multifactorial. For a segment of the cancer pain population, pain control remains inadequate despite full compliance with the WHO analgesic guidelines including use of co-analgesics. The failure to obtain acceptable pain or symptom relief prompted the inclusion of a fourth step to the WHO analgesic ladder, which includes advanced interventional approaches. Int...

BACKGROUND Addition of intrathecal magnesium sulfate to local anesthetics has been reported to potentiate spinal anesthesia and prolong analgesia in parturients. The current study was to determine whether intrathecal magnesium sulfate would reduce the dose of hyperbaric bupivacaine in spinal anesthesia with bupivacaine and sufentanil for cesarean delivery. METHODS Sixty healthy parturients un...

Spinal cord injury is a debilitating condition that currently lacks effective clinical treatment. Neurotrophin-3 (NT-3) has been demonstrated in experimental animal models to induce axonal regeneration and functional improvements, yet its local delivery remains challenging. For ultimate clinical translation, a drug delivery system is required for localized, sustained, and minimally invasive rel...

To the editor: It has been proposed that the intrathecal dose of hyperbaric bupivacaine for spinal anesthesia should be reduced in morbidly obese patients undergoing cesarean delivery. This recommendation is consistent with the lower volume of cerebrospinal fluid observed in patients with high body mass index, but a lack of definitive evidence has been noted. Previously, Ginosar et al. reported...

To the editor: It has been proposed that the intrathecal dose of hyperbaric bupivacaine for spinal anesthesia should be reduced in morbidly obese patients undergoing cesarean delivery. This recommendation is consistent with the lower volume of cerebrospinal fluid observed in patients with high body mass index, but a lack of definitive evidence has been noted. Previously, Ginosar et al. reported...

Intraspinal drug delivery (IDD) has been increasingly utilized since 1980s, initially in patients with cancer pain, and subsequently in patients with intractable, chronic, nonmaligmant pain. By infusing a small amount of opioid into the cerebrospinal fluid in close proximity to the receptor sites in the spinal cord, profound analgesia may be achieved while sparing some of the side effects due t...

Management of chronic pain by intrathecal delivery is gaining increasing use. The aim of this article is to review the literature pertinent to implantable devices used for treatment of chronic pain, and to highlight what is known. Articles were obtained from Medline database and reviewed. Practical patient selection criteria, trial management, and surgical technique are described. Expert consen...

This article provides a summary of the updated British Pain Society Guidance on Intrathecal Drug Delivery for the management of pain and spasticity in adults. We aim to highlight the areas of the guidance that have been updated and to provide a concise summary.