Chapter 68 - Exploring Nonopioid Analgesic Agents for Intrathecal Use

Abstract

Intrathecal (IT) drug delivery technology has become one of the key arsenals in treating both nonmalignant and malignant chronic pain. However, only three compounds have been officially approved for use in IT pumps for pain management. The recent focus on the incidence and prevalence of serious adverse effects associated with opioids has renewed interest in searching for alternative compounds with improved side-effect profiles and efficacy. In this chapter we consider six candidate compounds for use in IT pumps. Review of the candidate compounds suggests that more research and clinical experiences are needed, and ultimately their approval for use by the United States Food and Drug Administration (FDA). Furthermore, review of each compound also suggests that future IT therapy might benefit from a combination therapy of FDA-approved IT compounds and other nonFDA-approved compounds for optimal pain management while mitigating side-effects, including potentially fatal side-effects associated with single-compound use in IT drug delivery systems.