Intrathecal Opioids for Chronic Pain: A Call for Evidence

The first implanted fixed rate pumps were used in humans in the mid 1980s [1]. In 1991 Medtronic® released the first programmable pump for human use [2]. The majority of the research and reports concern programmable pumps, and the best and most current systematic review of the literature only identified manuscripts on these devices, and only considered chronic non-malignant pain (AKA chronic non cancer pain- CNCP) [1]. Older reviews are available [3–5]. No review, nor our literature search, identified a Randomized Controlled Trial (RCT) of implantable pumps using opioids in CNCP; yet despite such lack of evidence, the devices are commonly used for patients with CNCP. In contrast, there is an FDA drug registry of RCTs available for implantable pumps using ziconotide in CNCP [6]; IntraThecal (IT) baclofen has been assessed for spasticity (but no RCT: see Taricco et …