Intrathecal Infusions for Intractable Cancer Pain: A Qualitative Study of the Impact on a Case Series of Patients and Caregivers

Abstract

Implanted intrathecal infusion devices are a necessary part of a tertiary level cancer pain management service for the unfortunate minority with intractable pain. Practical recommendations for care are made for palliative care programs contemplating offering intrathecal infusions.

Interventional anesthesia and palliative care collaboration to manage cancer pain: a narrative review

“…Disadvantages of this technique are that these catheters are prone to infection, migration, dislodgement, and that an external pump is required that will likely limit the patient's mobility. 47 Though these catheters can be inserted into the epidural space, intrathecal placement is usually preferred as there are fewer catheter-related issues (e.g., migration, catheter tip granulation), technical problems associated with epidural fibrosis, 63 and lower medication dose requirements. 62,63 Nevertheless, both options carry the risk of infection in the central nervous system.…”

“…47 Though these catheters can be inserted into the epidural space, intrathecal placement is usually preferred as there are fewer catheter-related issues (e.g., migration, catheter tip granulation), technical problems associated with epidural fibrosis, 63 and lower medication dose requirements. 62,63 Nevertheless, both options carry the risk of infection in the central nervous system. Although there are data showing a similar rate of central nervous system infection with epidural and intrathecal catheters, an epidural catheter has the theoretical advantage of having the dura as a natural barrier to prevent spread to the spinal cord.…”

Preferences of Caregivers and Patients Regarding Opioid Analgesic Use in Terminal Care

“…Specific proposals arising from this study include the following: The degree to which patients and caregivers wish to know their health status should be evaluated, talking carefully with them to determine their fears, feelings, and preferences. This requires a relationship of communication and trust and the avoidance of misunderstandings [7–9,30,31,33,55,56]. Accurate and reliable information should be given on opioid treatment (regardless of their knowledge of the prognosis), detecting and refuting any false beliefs or misunderstandings that may affect adherence to the treatment, its effectiveness, and patient safety [7,34]. Terminal patients should be encouraged to participate in decision making, preserving some feeling of control over their own lives and ensuring that the patients' own values are taken into account, given that physicians can hold inaccurate views of their patients' preferences [5–7,9,34,53,55–59]. …”

“…The degree to which patients and caregivers wish to know their health status should be evaluated, talking carefully with them to determine their fears, feelings, and preferences. This requires a relationship of communication and trust and the avoidance of misunderstandings [7][8][9]30,31,33,55,56]. 2.…”

“…3. Terminal patients should be encouraged to participate in decision making, preserving some feeling of control over their own lives and ensuring that the patients' own values are taken into account, given that physicians can hold inaccurate views of their patients' preferences [5][6][7]9,34,53,[55][56][57][58][59].…”