Neuromodulation : journal of the International Neuromodulation Society
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Spasticity can affect individuals with spinal injury, spinal disease, or multiple sclerosis. In most cases, spasticity is useful because it helps compensate for motor deficits. Oral medication is ineffective or produces intolerable side effects in ≅ 30% of patients with severe spasticity and surgeries can sometimes have effects inappropriate for patients requiring some degree of spasticity for function. ⋯ Although complications are relatively uncommon, most involve mechanical compromise of the catheter. Cost analysis shows that there is an overall savings associated with intrathecal baclofen therapy, primarily due to a reduction in required hospitalizations and medical care for conditions resulting from spasticity. Intrathecal baclofen is a safe, efficacious, titratable, reversible, and cost-effective treatment for severe spinal origin spasticity, including spinal cord injury, spinal cord disease, and multiple sclerosis.
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Although opioid therapy has been accepted for the treatment of patients with cancer pain, its use for nonmalignant pain is still regarded as controversial due to concerns about the development of tolerance and psychological dependence. However, recent studies indicate that there is a low incidence of addiction in patients who do not have a history of addictive disorders, and opioid use is increasing for long-term treatment in patients with nonmalignant pain. ⋯ These studies demonstrate that intrathecal opioid delivery produces short-term relief of specific symptoms and improves long-term outcomes such as patient functioning (measured by increases in activities of daily living [ADLs] and capacity to work), mood, treatment satisfaction, and quality of life, as well as decreases in oral opioid use. Furthermore, these studies showed there was no development of tolerance or addiction in patients who received long-term intrathecal opioid delivery.
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There is a need to develop alternative agents for intrathecal pain therapy for patients who either cannot tolerate the side effects of or who no longer obtain sufficient analgesia with opioids. The experimental use of several compounds in intrathecal drug delivery is currently in progress, with the development of clonidine as the single most important advance in the improvement of pain treatment. ⋯ Other possible effective agents for intrathecal delivery include bupivacaine, octreotide, and SNX-111. The preclinical and clinical profiles for these promising new intrathecal pain medications are discussed.