Abstract: |
Implantable intrathecal drug delivery systems (IDDSs) are a viable option in patients who have failed more conservative treatments for managing intractable chronic pain, spasticity, and cancer-related pain. Various individual medications—including baclofen, morphine, and ziconotide—as well as combinations of medications are used in practice when attempting to provide therapeutic treatment. Prior to permanently implanting an IDDS, performing a trial of the medications should be considered. The 2016 Polyanalgesic Consensus Conference (PACC) guidelines help provide clinicians with parameters regarding when a trial should be performed. Although various trialing methods exist, research has not proven one to be better than any other, which is echoed by the 2016 PACC guidelines. In this chapter, we will discuss the trialing methods, considerations with different medications, and the steps involved when performing an epidural and intrathecal trial. © 2024 Elsevier Inc. All rights reserved. |