Intrathecal Drug Delivery (IDD) Overview
For those suffering from chronic pain, IDD an intrathecal drug delivery system, or IDD, can offer a convenient and easily managed system for long-term pain relief. The spinal cord is filled with opioid receptors, all of which are involved in the modulation of pain. IDD takes advantage of these “local” receptors with delivery of the analgesic directly into the intrathecal space or spinal fluid. Systemic and central nervous system side effects can be reduced, compared to more traditional pain management treatments, with the very small amounts of medication necessary with this technique.
The Implantation Technique
Prior to surgical implantation, an epidural or intrathecal trial of the proposed medication is accomplished generally as an inpatient. The trial, accomplished with a temporary catheter placed percutaneously, can last as little as 24 hours or as long as one week depending on the receptor targets and agents used. Trial is deemed successful if the patient reports more than 50% pain relief. During the trial, any oral pain medications are reduced by half or more, to ensure accurate reporting of pain relief. Placement of the permanent infusion system is then scheduled electively.
Permanent implant of the infusion system, consisting of a single piece intrathecal catheter and a programmable pump or reservoir, is generally accomplished under a combination of local and spinal anesthesia, though general anesthesia is also an option. The procedure generally takes less than one hour. Overnight stay in a hospital is required for monitoring of the new system.
The newest SynchroMed infusion pump by Medronic offers both 20 and 40ml reservoirs. These new pumps often allow refills spaced as far as six months apart, making the IDD both convenient and easy to maintain. Additionally, there is a patient control feature allowing the delivery of additional medication on demand, within the prescribed limits.
Who can benefit from IDD
The indications for IDD are extensive, and include pain of visceral origin, somatic, neuropathic, and cancer pain. The only requirement is verifiable pathology as the cause of the pain and failure of more conservative pain management measures to reduce or control the pain.
CIPS physicians currently provide IDD therapy to over 200 local area pain management patients currently under our treatment programs.
You don’t have to live with pain anymore. If you are interested in learning more about this therapy option, or believe that an intrathecal drug delivery system may be right for your chronic pain, please ask your CIPS physician about it at your next scheduled appointment, or call us at 970-242-0162.