Neuraxial infusions

Background

Treatment of severe pain in the seriously ill patient, whether cancer-related or not, remains challenging. Although the use of basic medical management strategies is effective in most patients, some 10% to 20% or more cancer patients have pain, which is refractory to traditional pharmacotherapy. It has been suggested that a fourth, “interventional” step be added onto the three-step WHO analgesic ladder. Intraspinal analgesic infusions have been shown to be effective in the treatment of refractory cancer pain and in those patients with intolerable opioid-related side effects. A review of the basic pharmacology, patient selection, implant process, evidence of efficacy, and overview of complications is presented.

Conclusions

There is sufficient consistent evidence (one RCT, numerous prospective and retrospective series) to support the use of intraspinal analgesia for refractory cancer pain.

Keywords:  Intrathecal analgesia , Intrathecal therapy , Implantable pain pump , Spinal analgesia , Opioids , Chronic pain