Intrathecal analgesia is a highly effective analgesic technique that delivers medications directly into the cerebrospinal fluid via an implanted catheter connected to a programmable pump. This approach provides powerful analgesia by administering drugs as close as possible to the receptors involved in the nociceptive message in the posterior horn of the spinal cord, resulting in reduced adverse effects and improved quality of life for patients with refractory pain.

Intrathecal analgesia is indicated for patients with intractable localized pain, particularly in advanced cancer stages (15% of cancer patients with refractory pain). It’s recommended when pain is insufficiently controlled despite well-administered background treatment with morphine doses around 300 mg/day oral equivalent, or when adverse side effects rule out conventional analgesics. Early access is particularly recommended for pelvic cancers, pancreatic/liver cancer, Pancoast-Tobias syndrome, hyperalgesic bone metastases, sarcomas, and ENT cancers.

First-line intrathecal medications include morphine combined with local anesthetics (ropivacaine or bupivacaine) and ziconotide, per PACC 2017 guidelines. Morphine dose calculation is critical: 1/300 of the oral dose (not exceeding 5 mg/24h initially), ropivacaine at 6-8 mg/day, and ziconotide at 0.25-0.5 µg/day. Calculation errors can lead to overdose or underdose. The morphine-ropivacaine-ziconotide combination is stable for 21 days in a SynchroMed II pump when properly prepared.

Absolute contraindications include intracranial hypertension, brain metastases with herniation risk, and obstacles to CSF circulation in the catheter path (spinal cord invasion, compressive vertebral fracture). Relative contraindications requiring case-by-case discussion include aplasia, neutropenia, thrombocytopenia, hemostasis disorders, active infection, epiduritis, severe undernutrition, and certain cancer treatments like bevacizumab (anti-angiogenic agents).

Thalivia aims to significantly reduce prescription and pump programming errors, which represent a major risk factor in intrathecal therapy. The platform provides automated morphine dose calculations, real-time concentration verification, flow rate validation, and drug incompatibility alerts. By digitizing the prescription workflow (compliant with SFETD 2024 guidelines), Thalivia assists clinicians in minimizing programming errors and drug mixture preparation errors, while ensuring complete traceability of every prescription.

Thalivia is designed for pain management specialists, anesthesiologists, palliative care physicians, oncologists, and hospital pharmacists involved in intrathecal therapy. The platform supports both implant centers initiating treatment and downstream facilities providing follow-up and refilling of programmable pumps. The integrated physician-pharmacist collaborative workflow aims to reduce communication errors that can occur during complex prescriptions.

Thalivia primarily supports the SynchroMed II programmable implantable pump from Medtronic (currently the only pain drug infusion pump marketed in France). The platform also accommodates external pump protocols for patients with short-term prognosis or contraindications to implanted pumps. Automated calculations adapt to specific pump characteristics (reservoir volume, minimum/maximum flow rates) to assist in avoiding programming errors.

Thalivia integrates with hospital pharmacy circuits to support safe preparation of analgesic mixtures in ISO 5 cleanrooms. The platform enforces mandatory traceability of raw materials, proper storage conditions (refrigerated 2-8°C), and respects stability data for drug mixtures (21 days for morphine-ropivacaine-ziconotide per published data). The collaborative validation workflow between prescribers and pharmacists aims to reduce communication errors and drug incompatibilities before mixture preparation.

Multiple clinical studies demonstrate that intrathecal analgesia provides significant relief for patients with refractory pain who had few effective options. The technique is endorsed by French Formalized Expert Recommendations (SFETD/SFAR 2013), DGOS Instruction (2017), and HAS Recommendations (2020). International PACC (Polyanalgesic Consensus Conference) guidelines provide evidence-based protocols for drug selection and dosing, helping avoid complications from inappropriate combinations.

Serious adverse events can include preventable errors such as pump programming and drug mixture preparation mistakes. Complications include early issues (CSF leakage, post-LP headache, poor healing), late technical problems (catheter displacement, disconnection, pump shifting), and drug-related effects (morphine overdose, ziconotide psychiatric effects, local anesthetic neurological symptoms). Systematic protocols and automated calculations aim to reduce these preventable risks.

Refilling frequency depends on drug concentrations, flow rates, and reservoir size (typically 20-40ml). The classic morphine-ropivacaine-ziconotide mixture is stable for 21 days maximum, establishing the practical refill interval. Refilling requires sterile technique in day hospital settings with trained teams, patient assessment, prescription validation, and pharmacy preparation in laminar flow hoods. Thalivia automatically calculates the next refill date based on volume, concentrations, and programmed flow rate.

Yes, but timing is critical to avoid healing complications. It’s recommended to stop chemotherapy at least 15 days before implantation and resume 7-10 days post-op if healing is satisfactory. Immunotherapy has no foreseeable complications. Anti-angiogenic agents like bevacizumab require cessation 3 weeks before and resumption 15 days to 3 weeks after implantation. Radiotherapy is possible if the pump is outside the radiation field. MRI is compatible (pumps rated to 3T) with post-scan pump programming verification.

Thalivia is designed for clinicians already trained in intrathecal therapy who understand the medical aspects and validated protocols (SFETD, PACC). The platform requires only interface familiarity—no additional medical certification. We provide comprehensive onboarding with video tutorials, clinical documentation, and technical support. The goal is to assist clinicians in the prescription workflow while supporting safety standards: automated calculations, real-time validation, complete traceability.

Thalivia offers tiered pricing based on usage: Solo plan for individual practitioners, Team plan for collaborative workflows, and Enterprise plan with full institutional features (SSO, FHIR integration, pharmacy workflows, priority support). Beta access is available through December 2025, with V1 commercial launch in February 2026. Contact us for detailed pricing and institutional volume discounts.

Thalivia is undergoing CE Class I medical device certification (expected January 2026, commercial launch February 2026). The platform complies with GDPR for patient data protection and uses HDS-certified hosting infrastructure in France (Clever Cloud). It follows FHIR/HL7 interoperability standards and implements French health data security protocols: AES-256 encryption, role-based access control, complete audit trails, and redundant backups.

Sign up for a free account at thalivia.care or book a personalized demo to review your workflow, integration requirements, and implementation timeline. For institutions developing intrathecal programs, we provide guidance on team structure, pharmacy collaboration, patient circuits, and validation procedures. Beta access through December 2025 includes priority support and input on V1 feature development. Avoid startup errors with our personalized technical onboarding.