Chronic pain is a complex condition characterized by changes in the nervous system and clinical manifestations influenced by psychosocial and potentially iatrogenic factors. Repeated activation of the nociceptive system abnormally sensitizes the peripheral and central neural pathways that typically convert noxious environmental stimuli into perceived pain in the brain. These abnormal pathways can present clinically as severe, persistent, and functionally disabling pain, which is often challenging to manage despite individualized care with oral medications and psychosocial treatments. Attaining good outcomes for patients with severe chronic pain has recently become even more difficult because of the critical safety concerns and public health issues associated with prescription opioids.
Advanced pain management options should be considered when patients cannot reach their analgesic and functional goals with more conventional therapies. One advanced interventional modality involves delivering analgesics directly into the cerebrospinal fluid (CSF) via pump and catheter. The first pump providing low-dose morphine in a patient with cancer-related pain was implanted in 1981. Since then, several systematic reviews have demonstrated intrathecal drug delivery systems to be effective and safe for cancer-related and chronic noncancer pain.
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