• Jan Van Zundert and Richard Rauck.
• Department of Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Bessemerstraat, 478, 3620 Lanaken, Belgium; Anesthesiology and Pain Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands. Electronic address: jan.vanzundert@zol.be.
• Best Pract Res Clin Anaesthesiol. 2023 Jun 1; 37 (2): 157169157-169.

AbstractTargeted intrathecal drug delivery (TIDD) has the objective of bringing the drug(s) close to the receptors influencing pain modulation, and thus reducing the dose and the side effects. Intrathecal drug delivery knew its real start with the development of permanent implantation of intrathecal and epidural catheters, combined with internal or external ports, reservoirs, and programmable pumps. TIDD is a valuable treatment for patients with cancer suffering refractory pain. Patients suffering noncancer-related pain should only be considered for TIDD when all other options have been tested, including spinal cord stimulation. Only two drugs are approved by the US Food and Drug Administration for TIDD administration for chronic pain: morphine and ziconotide as monotherapy. In pain management, off-label use of medication and combination therapy is often reported. The specific action of the intrathecal drugs, the efficacy and safety, is described, as well as the modalities for trialing intrathecal drug delivery and the implantation methods.Copyright © 2023 Elsevier Ltd. All rights reserved.

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