Medical terminology and definitions used in intrathecal analgesia practice, compiled from the SFETD Intrathecal Toolbox 2024.
Relief from pain without loss of consciousness. Intrathecal analgesia specifically delivers medications into the cerebrospinal fluid for powerful pain control.
Cancer medications (like bevacizumab) that inhibit blood vessel formation. Require special timing considerations around intrathecal pump implantation (cessation 3 weeks before, resumption 15 days to 3 weeks after procedure).
Failure of an organ or tissue to develop or function. A relative contraindication for intrathecal therapy requiring case-by-case discussion.
An extra dose of medication delivered rapidly. In intrathecal therapy:
Local anesthetic used intrathecally at 40 mg/mL concentration. Effective for neuropathic pain; can extend time between pump refills due to higher concentration compared to ropivacaine.
Thin, flexible tube implanted in the intrathecal space (around spinal cord) to deliver medications. 4-layer compression-resistant design prevents kinking. Positioned at metameric level corresponding to pain location.
Clear fluid surrounding brain and spinal cord. The target space for intrathecal drug delivery.
Catheter positioned at neck level (C1-C5 vertebrae) for upper limb, ENT, or facial pain.
Catheter positioned at cisterna magna (base of skull) for head and facial pain management.
Alpha-2 adrenergic agonist sometimes used intrathecally as adjuvant analgesic (PACC second/third-line). Also used to manage opioid withdrawal syndrome.
Multidisciplinary team decision-making process required before intrathecal therapy initiation. Involves oncologists, pain specialists, anesthesiologists, radiologists, palliative care specialists, and others.
Medical condition that completely prohibits intrathecal therapy (e.g., intracranial hypertension, spinal cord compression, active infection).
Medical condition requiring careful evaluation and case-by-case discussion before proceeding (e.g., thrombocytopenia, neutropenia, undernutrition).
Direction Générale de l’Offre de Soins (French healthcare authority). Issued 2017 instruction recognizing intrathecal analgesia.
Inflammation of epidural space surrounding spinal cord. Relative contraindication requiring MRI evaluation before intrathecal therapy.
International standard for electronic health record interoperability. Thalivia uses FHIR for seamless integration with hospital systems.
Speed at which intrathecal pump delivers medication, measured in mL/day or mL/hour. Initial flow rate typically set at 1 mL/day for implanted pumps.
Mass formation at catheter tip (spinal mass syndrome). Rare complication associated with high morphine concentration at low flow rates. Presents as rapid loss of efficacy.
French national health authority. Issued 2020 recommendations endorsing intrathecal analgesia for refractory cancer pain.
French health data hosting certification. Required for platforms managing patient health information. Thalivia uses HDS-certified infrastructure.
Process of stopping bleeding. Hemostasis disorders are relative contraindications; anticoagulant management is critical before implantation.
Increased pressure inside skull. Absolute contraindication to intrathecal therapy due to herniation risk.
Complete system comprising implanted pump, catheter, and programming equipment. Also called “implantable pump” or “pain pump.”
Subcutaneous device (typically 20 mL or 40 mL reservoir) that stores and delivers intrathecal medications continuously. SynchroMed II from Medtronic is the only model currently marketed in France.
Literally “within the sheath”—refers to the space around the spinal cord containing cerebrospinal fluid. Route of administration for direct spinal analgesia.
Abbreviation for “intrathecal.”
Medications (ropivacaine, bupivacaine) that block nerve impulse transmission. Used intrathecally for neuropathic pain component.
Procedure to access intrathecal space by inserting needle between lumbar vertebrae (typically L3-L4 or L4-L5).
Spinal segment corresponding to specific body region innervation. Catheter must be positioned at appropriate metameric level for pain location.
Primary opioid used intrathecally. Dosed at 1/300 of oral dose or 1/100 of IV dose. Initial maximum: 5 mg/24 hours.
Medtronic remote control system allowing patients to self-administer boluses for breakthrough pain within prescribed limits.
Pain caused by nerve damage or dysfunction. Responds particularly well to intrathecal local anesthetics and ziconotide.
Pain caused by tissue damage or inflammation. Responds primarily to intrathecal opioids.
Low neutrophil count. Relative contraindication (PNN must be > 500/mm³ before implantation).
Class of analgesic medications that bind to opioid receptors. Morphine is the most common intrathecal opioid; fentanyl and sufentanil are alternatives.
Standardized measure converting all opioid doses to oral morphine for comparison. Used to calculate initial intrathecal morphine dose.
International expert panel providing evidence-based guidelines for intrathecal drug delivery. Most recent recommendations published 2017.
Superior sulcus tumor causing shoulder/arm pain. Early indication for intrathecal therapy per SFETD guidelines.
Complication after lumbar puncture: postural headache, stiff neck, nausea, vomiting, diplopia, transient hearing loss. Caused by CSF leakage. May be prevented with biocompatible sealing at puncture site.
See “IDDS” and “Implantable Pump.”
Percutaneous procedure to replenish medication in implanted pump reservoir. Performed under strict sterile conditions using specific Medtronic refill kit (ref 8551). Typical interval: every 21 days for morphine-ropivacaine-ziconotide mixture.
Pain that does not respond adequately to conventional treatments. Primary indication for intrathecal analgesia.
Lockout time between patient-activated boluses (typically 1 hour). Prevents overdose from repeated bolus administration.
Local anesthetic commonly used intrathecally in France. Dosed at 6-8 mg/day initially. Available at 10 mg/mL concentration.
French Society for the Study and Treatment of Pain. Developed the Intrathecal Analgesia Toolbox (2024) providing clinical practice guidelines.
French Society of Anesthesia and Intensive Care. Co-issued 2013 formalized expert recommendations for intrathecal analgesia.
Duration medications maintain therapeutic concentration and safety. Morphine-ropivacaine-ziconotide mixture: 21 days at 37°C in pump, 3 days at 2-8°C in syringe.
Surgical space created in abdomen or gluteal region to house implanted pump.
Programmable implantable pump manufactured by Medtronic. Currently the only intrathecal pain pump marketed in France. Available in 20 mL and 40 mL reservoir sizes.
Catheter positioned at mid-back level (T1-T12 vertebrae). Common placements:
Low platelet count. Relative contraindication (platelets must be > 80,000/mm³ before implantation).
Process of gradually adjusting medication dose to achieve optimal pain control with minimal side effects.
Surgical technique creating subcutaneous path for catheter between spinal insertion point and pump pocket.
Non-opioid analgesic that blocks N-type calcium channels. Particularly effective for neuropathic pain. Only available via intrathecal route. Initial dose: 0.25-0.5 µg/day, increased very gradually (0.1-0.2 µg/24h at each adjustment).
This glossary is compiled from the SFETD Intrathecal Analgesia Toolbox 2024 and international guidelines.