1. 2020;23;E591-E617Intrathecal Drug Delivery for Chronic Pain Syndromes: A Review of Considerations in Practice Management
   Narrative Review
   Alaa Abd-Elsayed, MD, Jay Karri, MD, Ashley Michael, MD, David Bryce, MD, Jennifer Sun, MD, Maxwell Lee, MD, Vwaire Orhurhu, MD, and Timothy Deer, MD.

BACKGROUND: Chronic pain syndromes are poorly understood and challenging to treat. However, intrathecal drug delivery systems (IDDS) have been shown to have good efficacy in treating various pain subtypes and patient populations. The success of IDDS interventions is largely dependent on consideration of and adherence to varying practice patterns.

OBJECTIVES: We aimed to review and report on the evidence basis for various considerations in IDDS practice management including: (1) patient selection and periprocedural criteria, (2) efficacy of IDDS for various conditions, (3) intrathecal medications, (4) drug delivery systems, (5) trial and implantation, (6) complications and adverse events, and (7) chronic follow-up.

STUDY DESIGN: We conducted an evidence-based narrative review.

METHODS: PubMed, Medline, Cochrane Library, prior systematic reviews, and reference lists were screened by 2 separate authors for all randomized trials, meta-analyses, and observational studies relevant to each of the aforementioned management principles and were considered for study inclusion.

RESULTS: All high-level evidence studies that explored the various facets for IDDS practice management were included for review.

LIMITATIONS: Despite existing evidence basis for practice considerations, current practice patterns are highly practitioner dependent. More and continued high-level evidence is necessary to support, affirm, and dictate principles in practice considerations.

CONCLUSIONS: Incorporation of the principles found in this evidence-based narrative, which is comprised of the highest level of evidence supportive of various facets of IDDS practice management, is essential to optimize outcomes, treatment efficacy, and safety profiles.

KEY WORDS: Chronic pain, intrathecal drug delivery, practice management