Introduction and Background for Intrathecal Pumps Used for Pain and Spasticity

Intrathecal drug delivery has expanded since the inception of this technology in the 1980s and is utilized for a number of different conditions for the purposes of pain control and the management of spasticity. The use of intrathecal pumps is less common than many other techniques for interventional pain management but is essential in such conditions as refractory pain, cancer pain, multifocal pain, severe spasticity, and in patients who are not candidates for surgical correction of their underlying condition. Intrathecal drug delivery is usually considered when analgesics or antispasmodics administered via the oral, transdermal, or intravenous routes are ineffective or are associated with unacceptable side effects. The intrathecal delivery of medications bypasses the blood-brain barrier, which produces much higher concentrations of medication within the cerebrospinal fluid. This higher concentration can serve to dramatically reduce the effective dose of the medication and can be associated with higher rates of pain and spasm reduction as compared to other routes of medication delivery. Although intrathecal drug delivery has been shown to be clinically effective and cost-effective, this pain and spasticity management tool is less well understood regarding its implantation and management than other implantable technologies. This chapter will serve to highlight the proper clinical use and appropriate management of intrathecal pumps for the management of spasticity and pain.