This chapter focuses on the various factors that play a role in choosing the delivery system for intrathecal analgesics. The commercially available implantable pumps are either fully programmable or constant infusion in design. The constant infusion systems are further subdivided into gas-driven or an elastomeric mechanism. Traditionally the costs associated with intrathecal therapy are classified into short-term and long-term economic considerations. The short term costs include purchase price of the pump, cost of drugs, and hospital follow-up episodes including inpatient stays and outpatient appointments. The long-term costs include costs related to time off work and disruption to life and debilitating costs of chronic pain. Programmable pumps have had the widest commercial acceptance and have continued to be the most favored by clinicians for a variety of reasons. The most obvious reason is the ability to change the program without having to access the pump reservoir. It is also less costly and less invasive for the patient. The downside to the current programmable pumps is the greater initial cost and the need to replace them when the battery becomes depleted. Clinicians are awaiting for more selective and targeted medications that will further the utility of intrathecal infusions and even broaden the applications. The future of implantable technology for intrathecal infusion also rests upon the political and socioeconomic decisions made by local and national governments and healthcare payers.
|Original language||English (US)|
|Title of host publication||Neuromodulation|
|Number of pages||10|
|State||Published - Jan 1 2009|
ASJC Scopus subject areas
- Clinical Neurology
- Anesthesiology and Pain Medicine