Neuromodulation
Reversible Modulation of Nerve Transmission
Intrathecal Drug Therapy (Medication Acting Locally Near the Spinal Cord)
Intrathecal Drug Therapy
In this procedure a medication, for example morphine, modulates neuronal transmission by acting
as a neurotransmitter. Other medications such as local anesthetics are also used.
The safety and effectiveness of the procedure is tested and established on a patient-to-patient
basis. Movement, feeling and sympathetic nerve system reflexes are not affected by the procedure.
Indications
- chronic pain of spinal cord origin which has not responded to systemic opiate therapy
unacceptable side effects associated with systemic opiate therapy
Value
An individual trail therapy is required before proceeding with intrathecal drug therapy.
Long-term follow-up including documentation of the therapy is mandatory.
Advantage
The dosis-dependent side-effects of opiate treatment can be significantly reduced.
Follow-Up
Physical therapy parallel to treatment is recommended with emphasis on the patient's pain-related
symptoms. As the level of pain decreases a carefully structured program of movement and strength
training is implemented.
Work
Resumption of work is possible after the therapy has begun to take effect and pain is reduced.
Sport
Mobility is often much improved after the therapy has begun to take effect.
Results
International conferences in Memphis in 1997 and in Brussels in 1998 lead to the development
of recommendations for the implementation of long-term intrathecal opiate therapy in the treatment
of cancer- and non-cancer-associated pain. The recommendations are based on retrospective studies
by Paice et al. and Winkelmüller. Both studies involved patients with cancer-associated pain and
patients with either non-cancer-associated neuropathies, nociceptive-associated pain and/or
nociceptive-neuropathy-associated pain. On average a pain reduction of over 60% was achieved with
a subsequent marked improvement in quality of living.
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neuromodulation. reversible modulation II
neuromodulation reversible modulation of nerve transmission