Since the advent of implantable IT drug delivery systems over 25 years ago, numerous advances have been made with regard to system technology, pharmacology, and patient selection. Whereas strong evidence exists for the use of IT therapy for cancer pain, the evidence supporting long-term efficacy in noncancer pain is less convincing. However, in carefully selected patients, combination therapy appears to provide the ideal balance between efficacy and side effects, at least for intermediate-term outcomes. Areas most ripe for future investigation include which pain conditions are most amenable to IT therapy, the long-term efficacy of infusion therapy for noncancer pain, particularly in regard to functional improvement, delineating which drug combinations provide the best balance between efficacy and adverse effects, and conducting preclinical and clinical safety studies on promising analgesics such as ketamine and midazolam.
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