Efficacy of intrathecal drug delivery system for refractory cancer pain patients: A single tertiary medical center experience

Lin, Chih-Peng; Lin, Wen-Ying; Lin, Feng-Sheng; Lee, Yow-Shan; Jeng, Chuen-Shin; Sun, Wei‐Zen

doi:10.1016/j.jfma.2011.03.005

Cited by 16 publications

(6 citation statements)

References 11 publications

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“…Despite a significant body of literature supporting the utilization of IDDS in cancer pain, worldwide utilization of this treatment modality remains relatively low when compared to the number of patients who would potentially benefit (3,18,19). In a randomized prospective study, IDDS showed improved pain scores, decreased toxicity, and increased survival when compared to conventional medical management (3).…”

Section: Discussionmentioning

confidence: 99%

“…IDDS has been shown to effectively reduce pain scores with better pain control and fewer adverse side‐effects after both 4‐ and 12‐week postimplantation, and has been associated with increased survival after six months . Another study found that pain scores decreased from 10 to 3.5 with administration of intrathecal analgesia, with patients showing functional improvements at 14 days with significant improvements in pain control and quality of life . IDDS has also been associated with reduced opioid toxicity, with one study demonstrating a 50% decrease in toxicity for IDDS patients compared to a 17% reduction in those with conventional pain management such as opioids .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Retrospective Analysis of Intrathecal Drug Delivery: Outcomes, Efficacy, and Risk for Cancer-Related Pain at a High Volume Academic Medical Center

Sayed

Monroe

Orr

et al. 2018

Neuromodulation: Technology at the Neural Interface

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Retrospective Analysis of Intrathecal Drug Delivery: Outcomes, Efficacy, and Risk for Cancer-Related Pain at a High Volume Academic Medical Center

Sayed

Monroe

Orr

et al. 2018

Neuromodulation: Technology at the Neural Interface

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“…In our series, the mean value on the visual analogue scale before the start of intrathecal infusion therapy was 7.78 ± 1.64 points, and this score is similar to that reported in other studies focussing on efficacy (Table 4). 5,[7][8][9][10][11][12][13][14][15][16][17][18][19][20] The comparison of VAS values before implantation with those 4 weeks after implantation (3.02 ± 2.44) represents a decrease of 4.75 ± 3.03 points. This decrease in the VAS scale after the first month after implantation is also similar to that published in most scientific articles, although it is a less studied aspect.…”

Section: Discussionmentioning

confidence: 99%

Predictive factors for efficacy and safety of intrathecal infusion devices for oncological pain

Fernández-Torres,

Fontán-Atalaya,

Peralta-Espinosa

et al. 2023

British Journal of Pain

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Introduction In an important percentage of intrathecal infusion therapy, the pain after implantation of a spinal device does not improve. Our objective is to identify factors that can predict therapeutic success and complications, developing a predictive model based on univariate and multivariate analyses. Methods Retrospective observational study, including 132 patients with oncological pain who were implanted with a fixed-flow device for intrathecal infusion. Four time points were established for data collection and, in addition to demographic and anthropometric data, variables related to oncologic pain pathology, initiation of therapy, pain control and complications were collected. Based on univariate and multivariate analyses, we performed predictive models on efficacy and complications. Results The mean baseline pain intensity was VAS 7.78, and when comparing the values before implantation with those at month 1, we observed an overall decrease of 4.75 points, maintained at months 3 and 6. Nocturnal pain progressively decreased in incidence from 50.0% before implantation to 21.8%, 9.1% and 4.3% at 1, 3 and 6 months. Episodic pain was present in 90.1% of the patients before implantation (7.79 episodes/day), and at 6 months the incidence remained at 53.8%. Most of the patients (66.6%) had no complications related to therapy. We constructed a highly significant multivariate model for the efficacy of the therapy with a predictive capacity of 30.2% and composed of factors: absence of nocturnal pain before implantation and clinical improvement on day 2 after implant. Regarding the prediction of complications, it was not possible to achieve a significantly multivariate effective model. Conclusion We identify two factors that predict therapeutic success in a multivariate model: the absence of nocturnal pain before implantation and the improvement of pain on the second day after implantation.

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“…For end-of-life patients with refractory pain, this system may provide profound analgesia with minimal side effects and allow patient care on an outpatient basis. Lin et al 16 confirmed that a totally implantable programmable drug delivery system was an attractive option for managing refractory cancer pain and could provide reliable long-term analgesia without permanent nerve or plexus destruction. Compared with other methods, we regard this epidural bupivacaine-morphine infusion system as the most efficient for pain relief.…”

Section: Discussionmentioning

confidence: 99%

Integrated approach to pain management for a patient with multiple bone metastases of uterine cervical cancer

Qin

Song

et al. 2018

J Int Med Res

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BackgroundPain management for multiple bone metastases is complex and often requires multidisciplinary treatment. We herein describe patient-centered multidisciplinary pain management for metastatic cancer.Case presentation: A 61-year-old woman with multiple bone metastases of uterine cervical cancer developed intractable low back pain. After external beam radiotherapy failed, we performed lumbar spinal intralesional curettage, pedicle screw fixation, and nerve decompression. However, the neuralgia persisted. We then percutaneously injected epirubicin into the intervertebral foramina under computed tomography guidance for L5 dorsal root ganglion destruction. Osteoplasty was performed under C-arm X-ray guidance; however, the sacrum was mistaken for the ilium, and treatment was ineffective. We administered zoledronic acid and strontium-89. The last resort was outpatient implantation of an epidural bupivacaine-morphine infusion system. A visual analog scale (VAS) was used for pain evaluation. Lumbar spinal intralesional curettage and fixation, epirubicin-induced ganglion destruction, and administration of zoledronic acid and strontium-89 decreased her VAS pain score from 7–8 to 3–4. Radiotherapy and nerve decompression and release were ineffective, as was osteoplasty because of the location error. The epidural infusion system decreased the VAS score from 7–8 to 2–3 and was highly efficient.ConclusionsMultidisciplinary integrated treatment for metastatic cancer can be effective.

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Efficacy of intrathecal drug delivery system for refractory cancer pain patients: A single tertiary medical center experience

Abstract: Intrathecal morphine delivery by using totally implantable programmable IDDS is an effective method to relieve refractory cancer pain.

Cited by 16 publications

References 11 publications

Retrospective Analysis of Intrathecal Drug Delivery: Outcomes, Efficacy, and Risk for Cancer-Related Pain at a High Volume Academic Medical Center

Retrospective Analysis of Intrathecal Drug Delivery: Outcomes, Efficacy, and Risk for Cancer-Related Pain at a High Volume Academic Medical Center

Predictive factors for efficacy and safety of intrathecal infusion devices for oncological pain

Integrated approach to pain management for a patient with multiple bone metastases of uterine cervical cancer

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