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Intrathecal drug delivery for cancer pain 

Intrathecal drug delivery for cancer pain
Chapter:
Intrathecal drug delivery for cancer pain
Author(s):

Louise Lynch

DOI:
10.1093/med/9780199661626.003.0017
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date: 27 September 2021

ITDD (intrathecal drug delivery) has been an option for the management of persistent cancer pain since the 1980s. The discovery of opioid receptors in the central nervous system was the impetus for early attempts to deliver opioids intraspinally. Approximately 1-2% of patients with cancer suffer inadequate analgesia from conventional medical management; this group particularly may benefit from ITDD. However, there is also some evidence for the use of ITDD in those with non-cancer pain. ITDD is also in common use for the administration of IT (intrathecal) baclofen to manage spasticity. This chapter describes continuous epidural and IT infusions by external pumps and IT infusions by implanted pumps. The intracerebroventricular mode of delivery of opioids is also well known and effective and can be used in head and neck cancer pain. This chapter is about practicalities rather than theory. The aims of the chapter are to describe patient selection parameters, to outline the systems and drugs available, and to discuss drug and patient management options in some detail, including a selection of case studies.

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