Pain treatment Anaesthetics/analgesics Intrathecal administration of drugs for
anaesthesia or analgesia can be utilized in the form of single-dose or continuous via
catheter with external or internal pump depending on indication and duration needed. Usually a combination of a
local anesthetic and one or more
adjuvant drugs are used. ====
Alpha-adrenergic agonists ==== Intrathecal
clonidine or
dexmedetomidine can be used to prolong duration of anaesthesia and analgesia but comes with increased risk of hypotension. ====
Opioids ==== Lipophilic opioids such as
fentanyl and
sufentanil can be administered intrathecally for short duration of anaesthesia and analgesia. Hydrophilic opioids such as
morphine, diamorphine and
hydromorphone can be administered intrathecally for longer duration of analgesia, up to 24 hours.
Pethidine has the unusual property of being both a local anaesthetic and opioid
analgesic, which occasionally permits its use as the sole intrathecal anaesthetic agent. Caution should be exercised with intrathecal opioids due to the risk of
hypoventilation. Hydrophilic opioids come with a dose-dependent risk of late onset hypoventilation, however, low-dose intrathecal hydrophilic opioids have similar risk for hypoventilation as systemic opioids. Other adverse effects of intrathecal opioids include nausea and vomiting,
pruritus and
urinary retention.
Atypical analgesic agents Ziconotide.
Antifungals Amphotericin B is administered intrathecally to treat fungal infections involving the central nervous system infections.
Cancer chemotherapy Currently, only four agents are licensed for intrathecal cancer chemotherapy:
methotrexate,
cytarabine,
hydrocortisone, and
thiotepa. Administration of any
vinca alkaloids, especially
vincristine, via the intrathecal route is nearly always fatal.
Baclofen Often reserved for
spastic cerebral palsy,
baclofen can be administered through an
intrathecal pump implanted just below the skin of the abdomen or behind the chest wall, with a catheter connected directly to the base of the spine. Intrathecal baclofen pumps sometimes carry serious clinical risks, such as infection or a possibly fatal sudden malfunction. ===
Antisense therapy=== Intrathecal administration of antisense oligonucleotides. Neurodegenerative diseases that are a result of a single mutant protein are good targets for antisense oligonucleotide therapies because of their ability to target and modify very specific sequences of RNA with high selectivity. Treatment of
spinal muscular atrophy with
Nusinersen is an example.
Mesenchymal Stem Cell Therapy Treatment of chronic spinal injuries via the administration of
mesenchymal stem cells, either from adipose tissue or bone marrow, is experimental, with better results from the former method. Introduction of mesenchymal stem cells promote the microenvironment needed for axonal regrowth and reduction of inflammation caused by astrocytes proliferation and glial scar tissue. Animal models have shown improved motor control under the site of injury. A clinical trial also showed statistically significant improved sensitivity under the site of injury in patients. ==See also==