Currently, the US FDA only approves morphine and baclofen for intrathecal use. However, other opioids are used for intrathecal delivery in a variety of clinical settings for pain management (acute or chronic, short or long term).
In their survey of clinical trends and decision making in intraspinal therapy, Hassenbusch et al demonstrated that large variations between practitioners were evident in the management of chronic nociceptive and neuropathic pain patients.
To date, there is a paucity of published literature on the effectiveness of intrathecal fentanyl in treating nonmalignant chronic pain patients.
Level 4 evidence did suggest some positive evidence on the effectiveness of intrathecal morphine in treating chronic nonmalignant pain. However, studies also showed that: 1. there was no patient selection criteria that guaranteed a high level of success of the treatment; 2. the use of intrathecal morphine was associated with a high incidence of side effects related to the drug itself, the drug delivery vehicles and the complications of surgery; 3. chronic nonmalignant pain patients treated with intrathecal morphine were usually also prescribed other analgesics, antidepressants and/or even oral opioids at the same time; 4. the cost effectiveness studies done on intrathecal morphine did not provide definitive evidence on its cost effectiveness due to the paucity of relevant data necessary to construct such a study. Methodological concerns around the one published study on cost effectiveness likely negate any of its conclusions.
