Intrathecal Therapy: The Burden of Being Positioned as a Salvage Therapy.

Dear Editor, In response to the editorial written by Drs. Harden, Argoff and Williams ⇓, similar calls for evidence for pain care therapies have been demanded before, spanning the breadth of our armamentarium, from oral opioids, to ultraminimally invasive surgeries, to epidural injections ⇓. Of note, this exact same article was originally published in this same journal 2 years ago ⇓, accentuating the importance that the conclusions merit a response. Historically, Intrathecal (IT) therapy has been plagued with positioning it as salvage therapy. Interestingly, however, despite this last-ditch position, success has been demonstrated by randomized controlled trials (RCT) focused on pain, employing ziconotide ⇓ and opioids for malignant and non-malignant pain ⇓. A thorough systematic review was performed in 2011, utilizing the United States Preventative Services Task Force (USPSTF) criteria, demonstrated level II-3 evidence for non-cancer pain studies meeting a strict inclusion criteria with at least 12 month follow-up, and level II-2 evidence for cancer related pain with at least 3 month follow-up ⇓. There is a lot of energy behind the clinical applicability of good, well-done, …

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