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