Intrathecal drug therapy: general considerations

Intrathecal drug-delivery systems have been used increasingly for management of pain and spasticity. The indications, efficacy, and cost-effectiveness of intrathecal therapy have not been established with certainty in randomized, controlled trials, but most available data indicate that intrathecal therapy can be a remarkably useful treatment of otherwise intractable pain and spasticity. Outcomes will undoubtedly improve further as we gain a better understanding of (and strict adherence to) patient selection criteria and mechanisms governing intrathecal drug actions while continuing to emphasize thoughtful patient and family education regarding therapeutic goals and their responsibility in helping to make the therapy successful.