A Brief History of Intrathecal Therapy

C. Douglas Stewart, PA/C MBADir. of Interventional Pain Medicine

Center For Pain ReliefCharleston, West Virginia

The Beginning Leonard CorningFollowed on Karl Koller’s work published in 1884 - cocaine1885 the first neuraxial anestheticGave rise to the idea that it might be possible to treat pain, acute surgical pain

Followed on His HeelsAugustus BierAbout 1898Injected his

AssistantInjected 6 patients Oh, and had his

assistant inject him.Mixed results

Next UPAbout 1900Rudolph MatasMixed Morphine and

Cocaine and got more stable results

Grafton LoveAbout 1935Neurosurgeon at Mayo ClinicDeveloped a flexible needleAnd used 5fr lacquered silk CatheterGot infectedNot reproducible

William LeonardAbout 1940Philadelphia SurgeonFlexible needle and used continuous infusion

New NeedleAbout 1944Edward B. TuohyDeveloped Tuohy

Needle

The Next Few Steps

Year Development Clinician1899 Successful demonstration of spinal anesthesia (Germany) August Bier1901 Sacral epidural local anesthetic injections to treat chronic pain (Fr) Jean-Anthanase Sicard1921 Single-shot lumbar epidural anesthesia (Spain) Fidel Page´s-Mirave´1933 Single-shot lumbar epidural anesthesia (United States) Archile Mario Dogliotti1938 Continuous lumbar epidural anesthesia (Romania) Eugen Bogdan Aburel1944 Continuous lumbar epidural anesthesia (United States) Robert A. Hingson1949 First report of successful continuous lumbar epidural anesthesia (US)Manuel Martinez Curbelo

Another Advance,

The use of plastic catheters was first described by Flowers in 1949. The first polymer (plastic)was polyethylene, which had been introduced as biomaterial for epidural catheters.

but why now??

What Happened Between 1941 and 1945?

World War 2

Technology Boom

Set The StageManufacturing

New PlasticsTechniques

ChemistryBetter Understanding Of How Drugs WorkedNew Drugs

NEW SCIENCE ABOUNDS

And The Race Is On1960 Choh Hao Li identified beta-endorphin

More work followed1973 Candace Pert & Solomon Snyder identify opiate

receptor1977 Tony Yaksh & Thomas Rudy Study direct spinal

action of narcotics in producing analgesia in rats1979 Epidural Morphine in Treatment of Pain (10)1981 First Report of continuous infusion of spinally

administered opioiods with constant delivery pump1982 numerous reports of improvement of both

epidural and intrathecal routes constant delivery pump

Still Racing On1986 High Dose Morphine Produced

Hyperesthesia1987 Chronic Intrathecal morphine for

intractable pain (43)Pump Technology GrewContinuous infusion VS. ProgrammableEach iteration gets better

What’s NextI truly do not knowSets stage for where we are now