Choice of intrathecal drug in the treatment of neuropathic pain – new research and opinion

ABSTRACT

Introduction: The choice of the proper intrathecal drug to treat neuropathic pain has been subject to much debate in recent years.

Areas Covered: Currently, the United States Food and Drug Administration (USFDA) has approved two drugs for chronic intrathecal use for the treatment of pain; however, there has been substantial growth in the development of other intrathecal drugs that can be used for neuropathic pain. We performed a PubMed literature search looking at intrathecal drug research for neuropathic pain between January 2005 to May 2019 and discuss current practices and mechanisms in treating these complex patients.

Expert Opinion: On-label intrathecal drugs are recommended if efficacious with acceptable side effects. In those suffering from neuropathic pain, clinical evidence suggests additional drug algorithms for treating these patients are necessary. There is ample room for growth in the development and approval of novel drugs for intrathecal delivery to manage neuropathic pain.

KEYWORDS:

• Neuropathic pain
• intrathecal
• drug
• delivery
• ziconotide
• morphine
• intrathecal drug delivery system
• refractory

Article highlights

• Intrathecal therapy remains a viable option for the management of neuropathic pain in patients who have failed conservative therapy and other interventional options

• Currently, limited pharmacologic options exist for intrathecal treatment of neuropathic pain

• The Polyanalgesic Consensus Conference criteria (2016) guide the use of intrathecal medications for various pain conditions

• Several new classes of medications continue to be studied as potentially offering benefit in IT therapy of neuropathic pain

• FDA approval of novel medications for use in the intrathecal space is awaited to offer patients effective, multimodal therapy

Declaration of interest

T Deer is a consultant for Abbott, Vertos Medical, Flowonix, Axonics, SpineThera, Saluda Medical, Nalu Medical, Vertiflex, and Ethos. He has Stock Options with Bioness, Vertos, Axonics, SpineThera, Saluda, Nalu, Vertiflex, and Cornerloc. Paid research with Abbott, Saluda, Mainstay, and Vertiflex. Patent Pending with Abbott. M Malinowski is a consultant for Nuvectra, Abbott, and SI-Bone. J Pope is a Consultant for Abbott, Flowonix, SPR Therapeutics, Tersera, Vertiflex, Saluda, Stimgenix. Research Flowonix, Saluda, Abbott. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper is not funded.