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Intraspinal Drug Infusion

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Central Pain Syndrome

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Abstract

Several drugs have been administered intrathecally (IT) in attempting to treat CP. Unfortunately, no well-designed studies with homogeneous groups of patients and long-term follow-up are available for definite conclusions. However, drug combinations (e.g., midazolam/clonidine/bupi- or ropivacaine or baclofen/clonidine/bupi- or ropivacaine) may be more effective; tolerance may develop more slowly. Since the dosage of each single drug is reduced, side effects might be fewer—although not necessarily. Intraspinal infusion is not risk-free: aside from generic ones (catheter dislodgement [IT>epidural], root irritation [IT>epidural], reactive arachnoiditis [IT>epidural]), infective complications are the most feared, with occasional mortality; bleeding, neurological injury, and cerebrospinal leaks are also possible. Intermittent boluses or continuous infusion shows no difference in predicting trial and long-term success, at least for opioids [1]; a positive preimplantation test does not guarantee long-term relief.

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Authors and Affiliations

  1. HEAVEN/GEMINI International Collaborative Group, Turin, Italy

    Sergio Canavero

  2. AOUCittà della Salute e della Scienza di Torino, Department of Neurosciences, Rita Levi Montalcini, Università di Torino, Turin, Italy

    Vincenzo Bonicalzi

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  1. Sergio Canavero
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  2. Vincenzo Bonicalzi
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Canavero, S., Bonicalzi, V. (2018). Intraspinal Drug Infusion. In: Central Pain Syndrome. Springer, Cham. https://doi.org/10.1007/978-3-319-56765-5_25

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