Drug Infusions around the Spinal Cord
Because, as discussed elsewhere on this site, much of the modulation of pain impulses happens at the level where the relevant nerves enter the spinal cord this area is a useful site for drug action. Sometimes, particularly for patients with severe pain in advanced cancer, it can be necessary and appropriate to deliver painkilling medications directly into the spinal fluid to target this site.
This access is done using a tube implanted into the spine, either into the space just outside the spinal fluid and nerves (epidural) or into the fluid itself (intrathecal). In our practice, for longer term use rather than short-term after operations, we normally use the intrathecal approach. These tubes can lead either to a portable pump outside the body or be supplied by a fully implanted pump under the skin, that can be reloaded by injection through the skin into the pump.
As is the case with many centres aound the UK, we are cautious about using intrathecal drug delivery in patients with the exception of those with pain resulting from advanced cancer. In the context of our work with cancer patients, when we use infusions this is normally with an external pump, normally using a combination of local anaesthetic and an opioid drug. This is discussed in more detail on this linked page.
Very occasionally, patients' pain may be treated using a fully implanted spinal pump to deliver opiates or other drugs, and there are a few patients in Gloucestershire with these pumps running. Some information regarding these pumps is available at the Medtronic website.
The British Pain Society has produced an information booklet "Intrathecal drug delivery systems for treating pain and spasticity: information for patients (2008)". These guidelines were launched at the joint Annual Scientific Meeting of the Benelux Neuromodulation Society & The Neuromodulation Society of UK & Ireland.
You can download a copy of the 2008 document, free of charge, by clicking here.
There is also useful information at the International Neuromodulation Society's website.
The British Pain Society has published a book on cancer pain, one chapter of which (partly authored by Drs de Courcy and Young) deals with interventions including spinal drug infusions, and this can be downloaded from this link. As noted on the linked page on Tunnelled Intrathecal Catheters for Cancer Pain, Dr de Courcy has written a detailed article on interventional treatments in cancer pain which is linked to this page.
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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
Page updated 19/02/2016