Doctors Cautiously Endorse Cerebrospinal-Fluid Pain Therapy

Injecting painkillers into the thin layer of fluid surrounding the brain and spinal cord can be effective in relieving pain and restoring function, but there are many risks associated with the procedure, which should be used only as a last resort, specialists said.

The physicians, who spoke at a meeting of the American Academy of Pain Medicine, criticized the freewheeling use of pain medications and technologies, which include implantable, programmable pumps and catheters to deliver the drugs.

“It is important to use an approved catheter with an approved drug,” Timothy Deer, of the Center for Pain Relief in Charleston, W.Va., said regarding the issue of off-label, or non-prescribed, use of various analgesics. “Clinicians are putting drugs in the pumps with absolutely no reasoning for it, and are doing some outrageous things.”

At present, only the painkillers morphine and ziconotide are approved by the U.S. Food and Drug Administration for use in so-called intrathecal pumps. The term intrathecal refers to the narrow space underneath the membrane that envelops the brain and spinal cord. The pumps are used for managing chronic, debilitating pain and for treating severe spasticity originating in the brain or spine.
   
“Regulation can be a good thing,” said moderator Leonardo Kapural, of the Cleveland Clinic in Ohio. In addition, he urged doctors to view intrathecal pain therapy as a treatment to use when all else has failed. A number of intrathecal-therapy complications were pointed out. Among the pump complications noted were infection, the development of an inflammatory mass, respiratory depression, neurological injury or paralysis, and even death.
   
Catheter complications that were noted included disconnection, breakage, leakage, migration, kinking and the formation of nodular tissue masses. The presenters also warned the specialists to watch out for pump programming errors and overuse of opioid drugs that could result in dependency.