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Intrathecal Opioids for Chronic Noncancer Pain

July 24, 2019

Health Problem: Chronic pain, or pain persisting > 6 months, is a multifaceted condition with an estimated prevalence of 2% to 40% in adults in the United States. There are numerous etiologies of chronic noncancer pain. Treatment of chronic pain depends on individual and pain-related factors. Common treatments include oral analgesics, injection therapies, and surgery. Implantable devices, such as spinal cord stimulators or implanted drug delivery systems, may be considered in patients who do not respond to or cannot tolerate other treatments.

Technology Description: Implanted drug delivery systems for intrathecal (IT) drug administration consist of a catheter and a constant-flow or a programmable pump that delivers the drug directly into the cerebrospinal fluid within the IT space of the spinal column. Morphine and ziconotide (a non-opioid drug) are the only 2 agents approved by the Food and Drug Administration for IT analgesia.

Controversy: There is a lack of evidence from well-designed controlled or comparative studies that compare IT opioid administration with conservative measures and that compare different opioids alone or in combination with local anesthetics in noncancer pain patients.

Key Questions: 

  • Are IT opioids administered via an implanted drug delivery system effective for the treatment of chronic noncancer pain?
  • Are IT opioids safe for the treatment of chronic noncancer pain? 
  • Have definitive patient selection criteria been established for IT opioids in the treatment of chronic noncancer pain?