Spinal analgesia in terminal care: Risk versus benefit

Abstract

Cancer pain treatment is well established. The World Health Organization provides clinicians an "analgesic ladder" scheme to optimize cancer pain treatment. At the beginning of the pain treatment, oral analgesic administration is preferred. The analgesic dose must be individualized. Many published papers describe the spinal administration of opioids in combination with various other drugs such as bupivacaine in selected patients with cancer pain. Although complications have been reported to be few, some recent reports debate this idea. We first describe a population of 92 cancer patients, 13 of whom received intrathecal morphine. We then present our experience with a separate group of 33 cancer patients who were also managed using intrathecal morphine. Based on this experience, the generally accepted indications for the technique appeared to be justified. Concern about spinal infection is well considered, however. Three out of those patients developed meningitis, a complication rate that is far too high.

The Significance of Intrathecal Opioid Therapy for the Treatment of Neuropathic Cancer Pain Conditions

“…The number and severity of side effects and complications in this study were comparable with those in other studies and, in most cases, appeared during the first 2 weeks of treatment [5,8,12]. No specific side effects were observed in connection with the individual pain mechanisms.…”

“…Since pharmacokinetics vary significantly during intrathecal medication application as compared to oral application, these results cannot be generalized [3,4]. Very few studies have followed this line in examining treatment results [5][6][7][8]. This study was aimed at examining the effectiveness of the intrathecal opioid therapy in regard to different cancer pain mechanisms.…”

Sensory neuron targeting by self-complementary AAV8 via lumbar puncture for chronic pain

“…In a clinical trial, IT opioids were superior to systemic opioids (14). However, IT opioid administration in patients requires the implantation of a pump and a permanent IT catheter, which has been associated with high complication rates (15)(16)(17), and is therefore, in practice limited to use by specialized medical teams at select centers.…”

Controversies over spinal treatment in advanced cancer patients

“…The quality of analgesia appears to be better with continuous infusion than with intermittent boluses of morphine [9]. Practical advantages with continuous administration of epidural morphine are evident in the treatment of patients to be followed in the home setting [17,45].…”