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An overview of intrathecal drug delivery

Intrathecal drug delivery has been used to treat chronic pain since the 1970's, and has been used in thousands of patients around the world.

What is intrathecal drug delivery and how does it work?

Intrathecal drug delivery utilises a small pump that is surgically placed under the skin in the abdomen. A pain-relieving drug, such as morphine,
is contained inside the pump, and is delivered through a small, soft tube called a catheter, directly into the area surrounding the spinal cord (intrathecal space). The spinal cord is like a highway for pain signals on their way to the brain, where the feeling of pain is experienced. As the pain-relieving drug is delivered directly to the spinal cord where these pain signals travel, intrathecal drug delivery can offer significant pain control, with much lower doses of medication than would be required with pills or injections. This helps to minimise side effects that often accompany other treatments.

How effective is intrathecal drug delivery?

Intrathecal drug delivery has been shown to provide effective pain relief in 60-80% of patients.^4,11,12,13 In addition, it has been shown to improve patients overall mood, as well as reducing the need for additional pain medications.¹⁴ This has helped many patients with severe pain improve their quality of life and participate more fully in daily activities, in many cases enabling patients to return to work.

Components of an intrathecal drug delivery system

An intrathecal drug delivery system is a totally implantable and programmable system, which consists of two parts - the catheter and the pump - that are both placed inside the body during
an operation.

Implantable Programmable Pump

The catheter is a small soft tube. One end is connected to the pump and the other is placed into the area surrounding the spinal cord (intrathecal space)
The pump is a metal device that stores
and automatically releases prescribed amounts of a pain relieving drug through
the catheter, directly to the spinal cord.
Your doctor can quickly and easily change the amount, rate and timing of medication your pump delivers using a small, hand-held, computer-like programmer that controls the pump's memory.

Your doctor may also give you a small hand-held patient programmer that communicates with the pump via telemetry. In addition to a continuous infusion schedule, this programmer enables you to administer supplemental doses of medication, within limits set by your doctor if you experience breakthrough pain.

Once you receive your intrathecal drug delivery system, your doctor will periodically refill your pump with medication.
This is performed by inserting a needle through the skin into the pump's reservoir. Refill intervals are typically every 1-3 months, although this may vary depending on your prescription. The battery on your pump should last an average of 5-7 years, depending on the dosage prescribed by your doctor.

A patient administering
a supplemental dose
of medication with their
patient programmer

How do I know if intrathecal drug delivery will work for me?

Your doctor will perform a screening test that will allow you to experience the benefit of intrathecal drug delivery before you decide whether to have the system surgically implanted. This can be done as an outpatient procedure, or you may be admitted for a short hospital stay. The screening test can be done in one of two ways:

You can either receive a single injection or several injections of a small amount of pain medication into the intrathecal space.
You can receive a continuous infusion of pain medication that is delivered using a temporary catheter placed in the intrathecal space and attached to an external pump.

You may stay in hospital or you may return home with the external pump for several days or weeks.
People who do not experience adequate pain relief during the screening test will not receive the permanent implantation.

What risks are associated with intrathecal drug delivery?

Complications with intrathecal drug delivery are rare, and seen in a small number of patients. However, as the pump is surgically placed, surgical complications such as infections are possible. The catheter could become dislodged or blocked, or in rare cases, the pump could stop working. This could cause a reduction in or loss of pain relief and may require surgery to correct, but is an extremely rare situation.

Intrathecal drug delivery at a glance

How does it work ?

A small pump containing a pain relieving drug, is surgically placed under the skin in the abdomen and delivers pain-relieving drugs directly to the area around the spinal cord.
Intrathecal drug delivery is preceded by a screening test to help predict which patients
are most likely to benefit from the treatment.

What are the benefits ?

Intrathecal drug delivery provides effective pain relief in 60-80% of patients
As the pain relieving drug is delivered directly to the spinal cord, intrathecal drug delivery offers pain control with much lower doses of medication than would be required with tablets
Complications with intrathecal drug delivery are rare and seen in a small number of patients.

References

4. Lamer T. Mayo Clinic Proceedings 1994; 373-480
11. Paice J. J Pain Symptom Manage 1996; 11:71-80
12. Winkelmuller M. J Neurosurg 1996; 85:458-467
13. Tutak V. South Med J 1996; 89:295-300
14. Roberts. Eur J Pain 2001; 5(A):353-361