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Neurology 2002;59:S18-S24
© 2002 American Academy of Neurology

Neurology supplements are not peer-reviewed. Information contained in Neurology supplements represent the opinions of the authors and are not endorsed by nor do they reflect the views of the American Academy of Neurology, Editor-in-Chief, or Associate Editors of Neurology.

Treatment options for refractory pain

The role of intrathecal therapy

Mark S. Wallace, MD

From the Center for Pain and Palliative Medicine, University of California, San Diego School of Medicine, San Diego, California.

Address correspondence and reprint requests to Dr. Mark S. Wallace, University of California, San Diego School of Medicine, 9500 Gilman Drive, Suite 0924, La Jolla, CA 92093-0924; e-mail: mswallace{at}ucsd.edu

Intraspinal drug delivery represents an important treatment option for the management of chronic pain. Selection of candidates for this type of therapy requires careful evaluation of the patient, possibly including psychological screening. Although determining the efficacy of long-term intraspinal drug therapy has been challenging, several classes of agents have been identified to provide benefits in patients with a variety of pain types. Such agents include opioids, {alpha}2-agonists, sodium channel antagonists, and {gamma}-aminobutyric acid agonists. In addition, combinations of agents with distinct mechanisms of action may be therapeutically advantageous because many clinical pain states result from more than one mechanism.






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