Contraindications and Precautions for Intrathecal Pain Pumps

Contraindications

• The American Society of Clinical Oncology recommends that intrathecal pump therapy is explicitly contraindicated in patients with active infections, coagulopathy, or very short life expectancy 1, 2
• Arachnoiditis is considered a relative contraindication for intrathecal pump therapy due to the introduction of foreign material into an already inflamed and adherent subarachnoid space 1

Precautions for Consideration of Intrathecal Therapy

• Intrathecal therapy might be considered as a last resort if surgical detethering has been performed and residual neuropathic pain persists despite conservative management, with patients having failed extensive systemic therapy including oral opioids and adjuvant medications 1, 2, 3
• A mandatory trial with temporary epidural or spinal catheter demonstrating ≥50% pain reduction is required before permanent pump implantation 1, 2, 3
• Psychological evaluation documenting favorable candidacy for permanent pump implantation is required for non-malignant pain 2, 3, 4