The use of intrathecal drug delivery has emerged as a viable option for the long-term treatment of cancer-related pain, and significant evidence has emerged to bolster its place in our pain treatment armamentarium. Use of this therapy has grown dramatically for chronic noncancer pain, particularly for the treatment of chronic back pain. The evidence to support efficacy in this realm is growing, but it remains inadequate; patient selection remains empiric, and efficacy and long-term safety have yet to be established. At the same time, the complications associated with this long-term therapy have grown more evident, particularly the appearance of neurologic injury associated with catheter-tip granuloma formation. It is now clear that many of the actual drug combinations and concentrations in clinical use had not been adequately tested in preclinical models.
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