ABSTRACT
Nearly 50 years ago, the seminal experiments of Melzack and Wall, culminating in the gate control theory, coupled with the discovery of endogenous opioid receptors, helped shape modern understandings of pain and provided interventionalists a potent therapeutic gateway to neuraxial analgesia. This paper emphasizes the historical antecedents, present state, and emerging future of the neuromodulatory technique of targeted intrathecal drug delivery (TIDD) for chronic pain. The strengths of TIDD are its customizability, reversibility, programmability, and low risk profile. Its benefits are evidenced by improved pain relief and quality of life and reduced demand for health-care resources.
Subject(s)
Analgesics, Opioid/administration & dosage , Chronic Pain/drug therapy , Injections, Spinal/methods , Neoplasms/complications , Pain, Intractable/drug therapy , Quality of Life , Analgesics, Opioid/history , Chronic Pain/etiology , Chronic Pain/psychology , Drug Delivery Systems/history , History, 20th Century , History, 21st Century , Humans , Infusion Pumps, Implantable/history , Injections, Spinal/history , Pain Measurement , Pain, Intractable/etiology , Pain, Intractable/psychology , Treatment OutcomeSubject(s)
Contrast Media/history , Metrizamide/history , Spinal Cord/diagnostic imaging , Tomography, X-Ray Computed/history , Contrast Media/administration & dosage , History, 20th Century , Humans , Injections, Spinal/history , Lumbosacral Region , Metrizamide/administration & dosage , Neurology/historyABSTRACT
The application of opioids in the proximity of the spinal cord is a recent addition to the forms of treatment available for pain relief. During the last 20 years we have learned more about the intimate mechanisms of the action of opiates then we had in the preceding 5 millennia. Opium, in fact, has been used for medical purposes from prehistoric times. On the basis of the newly acquired knowledge, we are now applying opioids in more effective ways and providing more patients with long overdue relief of their pain.
