The main drawback of using this system being used more widely especially in our country is the cost. There should be reasonable life expectancy [at least three months] before consideration of implanting this device. Valuations of cost-effectiveness recommend that cost savings are achieved after 2 years in contrast to systemic pharmacologic therapy for chronic, non-cancer pain.
Complications related to intrathecal therapy can be technical, biological, or medication related. While the huge majority of difficulties are minor, some serious problems can occur include Granuloma formation that may be related to the amount and concentration of opiates, mostly with high concentrations of Morphine and Hydromorphone. Surgical intervention required is rare as most cases improve with weaning off the intrathecal opiate, replacing it with preservative-free saline which has been shown to reverse the course leading to resolution of the Granuloma. Granuloma may occur in as many as 3% of implanted patients and most are asymptomatic. Routine MRIs to rule out intrathecal Granuloma was not recommended by the authors of this prospective study given the relatively low incidence. The initial sign of Granuloma may be increased pain despite increasing opiate infusion; hence, clinical vigilance is of prime importance. Other difficulties of IDDS include catheter migration, catheter kinking, catheter fracture/ leakage, CSF leak, Seroma, Hygroma, Infection, Pump erosion through the skin and medication side effects pruritus, vomiting, nausea, respiratory depression and cognitive side effects may occur. It is important to realize that clinician skills and expertise is vital as programming errors can be lethal.