Evidence-based review of the literature on intrathecal delivery of pain medication

Evidence-based medicine depends on the existence of controlled clinical tri als that establish the safety and efficacy of specific therapeutic techniqu es. Many interventions in clinical practice have achieved widespread accept ance despite little evidence to support them in the scientific literature; the critical appraisal of these interventions based on accumulating experie nce is re goal of medicine. To clarify the current state of knowledge conce rning the use of various drugs for intraspinal infusion in pain management, an expert panel conducted a thorough review of the published literature. T he exhaustive review included 5 different groups of compounds with morphine and bupivacaine yielding the most citations in the literature. The need fo r additional large published controlled studies was highlighted by this rev iew, especially for promising agents that have been shown to be safe and ef ficacious in recent clinical studies. (C) U.S. Cancer Pain Relief Committee , 2000.