Spinal Drug Delivery Systems

Intrathecal Drug Delivery systems

A surgically implanted programmable pump and catheter that delivers medication directly into the intrathecal space where fluid flows around the spinal cord.

Because drug is delivered directly to where it’s needed most in the spinal fluid, it relieves pain or spasticity with smaller amounts of medication (approximately 1/300 of an oral dose) than when drug is taken orally. This method of delivery may help minimizes side effects that can result from oral medication.

Therapy Components

The Intrathecal Drug Delivery system consists of:

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  • Pump – a surgically placed, battery-powered programmable pump
    with a reservoir infuses the drug at a programmed rate via the
    catheter
  • Catheter – a flexible silicone tube delivers medication from the pump to your body
  • A drug that reduces severe spasticity or pain.

Intrathecal Medications

The US Food and Drug Administration approved the use of ITB Therapy (Intrathecal Baclofen Therapy) for the treatment of spasticity of spinal and cerebral origin in 1992 and 1996, respectively. Since that time, it has been successfully used in the treatment of spasticity caused by stroke, cerebral palsy, multiple sclerosis, and acquired brain and spinal cord injuries.

Chronic intraspinal (epidural and intrathecal) infusion of preservative-free morphine sulfate sterile solution in the treatment of chronic intractable pain.

Chronic intrathecal infusion of preservative-free ziconotide sterile solution for the management of severe chronic pain.

Screening test:

To determine whether ITB Therapy is expected to produce a helpful response, the patient undergoes an ITB Therapy screening test. The screening test for ITB Therapy requires the administration of a test dose via a small needle into the thecal space. Peak effect of the drug usually occurs within four hours. Patients who respond positively to the test dose can be considered for ongoing Therapy. During screening, patients must be monitored closely in a fully equipped and staffed setting, due to the risk of possible side effects.

Once it has been determined that therapy is likely to be effective, a surgeon performs an operation to place a battery-powered pump. The procedure typically lasts about 1 to 2 hours.

The entire hospital stay is usually 4 to 7 days, during which time the pump is programmed to deliver the best possible dose of drug. A notable decrease in pain or the tone of spastic muscles is usually noticeable within several days of the operation, but significant improvements in function may take longer to be evident.

The dose of drug can be adjusted whenever necessary by reprogramming the pump in the doctor’s office. The reservoir is refilled by injection as needed, usually every 1 to 6 months. When the batteries run low, about every 7 years, the entire pump is replaced.

Contraindications:

When infection is present; when the pump cannot be implanted 2.5 cm or less from the surface of the skin; when body size is not sufficient to accept pump bulk and weight; when contraindications exist relating to the drug; drugs with preservatives.

A permanent implanted pump by Dr Shiraz Munshi (Lt) & team at cheers interventional pain management.

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