Intrathecal Pump Mixtures

“Double, double toil and trouble; Fire burn and cauldron bubble.” This may have been fine in its day, but we just get our mixtures from Bill Stuart at Hartley Pharmaceuticals in Long Beach. Most of the better pain clinics and hospitals in the western United States agree. In fact I’m not sure that I know anyone who is still using the witches?

The first drug used for intrathecal therapy was morphine over 100 years ago and morphine is still the most commonly used drug in pumps today. There are many reasons for this. Morphine is potent, stable, hydrophilic (so that it spreads well) and cheap. However morphine is not perfect or the best drug in every case. Certain side effects such as itching and nausea are more common with morphine than other narcotics. Morphine is a narcotic and like most narcotics, whether administered inside of the spine or out, it is not particularly effective against neuropathic pain.

 

In order to overcome some of these difficulties there are many drugs that can be added to morphine or substituted for morphine. Among the narcotics hydromorphone, fentanyl and sufentanyl have been used and continue to be used with high rates of success, where morphine is not tolerated. Local anesthetics can be surprisingly effective against both nociceptive and mild forms of neuropathic pain. Alpha 2 agonists, while rarely used alone can extend the therapeutic range of other drugs, but usefulness can be limited by a propensity to induce hypotension. Prialt, a type N calcium channel blocker, originally isolated from the venom of poisonous sea snail indigenous to the Philippine Islands is amazingly effective against all types of nociceptive pain as well as moderate to severe neuropathic pain. Finally, benzodiazepines, butyrophenones as well as NMDA antagonists have all been used in special circumstances.

 

The accurate and sterile compounding of these infusion mixtures is a job for professionals. At Schlesinger Pain Centers we have always gotten our intrathecal infusion mixtures from Bill Stuart at Hartley Pharmaceuticals. His attention to detail, unsurpassed quality and formidable fund of knowledge derived from a lifetime of clinical experience have made him the choice of most of the best pain clinics and hospitals in the western United States.

 

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