Introduction Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by the cardinal motor features: rest tremor, bradykinesia, rigidity, and loss of postural reflexes. The pathological hallmark of PD is degeneration of dopaminergic neurons in the substantia nigra pars compacta…
Relevant History of the Topic Including Developments Over the Past Decade The application of neurostimulation to the management of chronic pain syndromes remains a significant challenge for chronic pain specialists. The origins of deep brain stimulation for intractable pain can…
Introduction Intrathecal baclofen therapy (IBT) has been used for 3 decades in the management of spastic hypertonia associated with the upper motor neuron syndrome ( ). This chapter will describe patient selection, initial trialing, management of the newly implanted patient,…
Introduction From a historical standpoint, pharmaceutical compounding dates back 5000 years. The practice of apothecary is mentioned in the Bible as a trade. Apothecaries or physicians would compound oils, powders, aromatics, and elixirs to treat various medical conditions. Many compounds…
Introduction The use of intrathecal (IT) therapies for the control of chronic pain has become an important part of the treatment algorithm for those who suffer with chronic disease. In the effort to control suffering, these therapies have been used…
Introduction Intractable cancer pain continues to be a significant issue for oncological care. Although the spread of the disease may be controlled, symptom management for nausea, vomiting, lack of appetite, and pain control can be elusive. Interventional treatments, such as…
Introduction Intrathecal drug delivery systems (IDDSs) for chronic pain work by delivering a solution of an analgesic compound directly into the cerebrospinal fluid (CSF) for greater analgesic efficacy and minimal side-effects, as opposed to administering it through the systemic route.…
Introduction This chapter reviews the relationships between cerebrospinal fluid (CSF) dynamics and drug biodistribution following intrathecal (IT) administration. We attempt to provide the reader with a very thorough state-of-the-art review of the assessment of CSF dynamics that occurs with natural…
Introduction The history of intrathecal (IT) implantable drug delivery system (IDDS) therapy for chronic cancer and noncancer pain is rooted in experimentation with local anesthetics administered into the cerebrospinal fluid (CSF). For a thorough historical review see Chapter 60 .…
Introduction The systematic study of spinal systems and their transmitter biology has shown them to play a defining role in the encoding of afferent input and the tuning of autonomic and somatomotor outflow. Studies on the pharmacology of these spinal…