ABSTRACT
Intrathecal drug delivery systems are a means to provide direct administration of medications into the cerebrospinal fluid (CSF). In 1981, the first use of an implantable intrathecal drug delivery system was reported for the management of cancer pain. In 1991, externally programmable, battery-powered intrathecal drug delivery system pumps were introduced, allowing for noninvasive dose changes using an external programmer. While there are no universally accepted guidelines for patient selection, those suffering from intolerable side effects of oral, intravenous, or transdermal therapies as well as those unable to obtain adequate analgesia despite high opioid doses should also be considered for intrathecal drug delivery systems. Evaluation and management of comorbid conditions should occur prior to consideration of an intrathecal drug delivery system. The advantage of intrathecal drug delivery is that it may reduce the systemic side effects. In addition to pain, intrathecal drug delivery systems can be used to manage spastic hypertonia though the administration of baclofen.
