History of Intrathecal Drug Delivery
Intrathecal infusions of analgesics have been utilized increasingly since the late 1980s for the treatment of persistent pain. Early credit goes to Leonard Corning, who administered neuraxial local anesthetic in 1885. Corning’s work led to an interest in using this method to treat pain during surgery, with chronic pain being of little interest in initial development of these methods. Morphine may have been administered spinally as early as 1901. The use of opioids in the spine then underwent a long void in advancement. A breakthrough came in 1971 with the discovery of specific opioid receptors in the spinal cord. Yaksh and Rudy demonstrated the efficacy of analgesia from intrathecal opioids in animal models in 1976, and Wang and colleagues reported the treatment of cancer pain with morphine in 1979. With the development of implantable, programmable, continuous drug delivery systems in the 1980s, the use of intraspinal opioids became part of the modern treatment algorithm. The availability of these devices led to interest in using pumps to treat cancer pain, noncancer pain, and intractable spasticity.