Intrathecal analgesia: Time to consider it for your patient?
When systemic analgesics or antispasmodics fail to control chronic pain or cause intolerable adverse effects, an intrathecal drug delivery system may be the best bet.
In cases of mild neurologic symptoms, a transition to saline infusion through the pump may allow the granuloma to absorb; more severe cases may require neurosurgical intervention.47
Is your patient scheduled for an IT drug trial?
If a patient of yours is scheduled for an IT drug trial, ideally followed by pump implantation, microdosing—the practice of weaning the individual from oral opioids prior to the procedure so that very low doses of IT opioids will suffice—may play a role.48,49 While this approach appears promising, however, there is little in the way of definitive evidence of efficacy.
CASE › Over time, Ms. G’s maintenance IT dose of morphine had to be slowly increased from 0.5 mg to 1 mg/d. At bimonthly visits with her FP, she consistently reports pain scores of 3 on a scale of 1 to 10. The patient’s function has returned to baseline, and she has minimal adverse effects.
CORRESPONDENCE
Jessica Tsukanov, DO, Montefiore Medical Center, 3347 Steuben Avenue, Bronx, NY 10467; jtsukano@montefiore.org
