Complications of Intrathecal Therapy

Intrathecal therapy has been suggested as an advanced therapy for patients with cancer and noncancer pain after systemic medicines have failed. Pain management with intrathecal therapy has been shown to improve pain control and side effects over systemic analgesics alone. However, significant side effects and complications can occur with implantation and management of these devices. In addition to routine complications that occur with any surgical procedure, the pumps, catheters, and drugs infused in the pumps all carry their own complications. Spinal cord injury and nerve injury, cerebrospinal fluid leaks, and systemic and local infections can occur with the initial implantation of the pumps and catheter systems. Catheters can fracture, kink, and migrate resulting in immediate discontinuation of analgesia and precipitation of withdrawal. “Pump dumps” or release of large concentration of analgesics acutely could lead to overdose and death. Various drugs have been associated with the formation of granulomas, or inflammatory masses at the tip of the catheters. Centrally administered drugs can lead to numerous side effects. Conclusion.  While intrathecal drug delivery systems are a very valuable tool in the pain physician's armamentarium, they do carry risks for complications that must be considered and identified by both implanting and managing physicians. A knowledge of these risks and complications, and how to avoid them, is a necessary part of the pain physician's practice.