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Intrathecal Drug Delivery and Spinal Cord Stimulation for the Treatment of Cancer Pain

  • Other Pain (A Kaye and N Vadivelu, Section Editors)
  • Published:
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Abstract

Purpose of Review

The purpose of the present investigation is to summarize the body and quality of evidence including the most recent studies in support of intrathecal drug delivery systems and spinal cord stimulation for the treatment of cancer-related pain.

Recent Findings

In the past 3 years, a number of prospective studies have been published supporting intrathecal drug delivery systems for cancer pain. Additional investigation with adjuvants to morphine-based analgesia including dexmedetomidine and ziconotide support drug-induced benefits of patient-controlled intrathecal analgesia. A study has also been recently published regarding cost-savings for intrathecal drug delivery system compared to pharmacologic management, but an analysis in the Ontario, Canada healthcare system projects additional financial costs. Finally, the Polyanalgesic Consensus Committee has updated its recommendations regarding clinical guidelines for intrathecal drug delivery systems to include new information on dosing, trialing, safety, and systemic opioid reduction. There is still a paucity of clinical evidence for spinal cord stimulation in the treatment of cancer pain. There are new intrathecal drugs under investigation including various conopeptides and AYX1.

Summary

Large, prospective, modern, randomized controlled studies are still needed to support the use of both intrathecal drug delivery systems as well as spinal cord stimulation for cancer pain populations. There are multiple prospective and small randomized controlled studies that highlight a potential promising future for these interventional modalities. Related to the challenge and urgency of cancer pain, the pain practitioner community is moving toward a multimodal approach that includes discussions regarding the role of intrathecal therapies and spinal cord stimulation to the individualized treatment of patients.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Fangfang Xing, R. Jason Yong & Richard D. Urman

  2. Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, New Orleans, LA, USA

    Alan David Kaye

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  1. Fangfang Xing
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  2. R. Jason Yong
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Correspondence to Richard D. Urman.

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Fangfang Xing, R. Jason Yong, Alan David Kaye, and Richard Urman declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Other Pain

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Xing, F., Yong, R.J., Kaye, A.D. et al. Intrathecal Drug Delivery and Spinal Cord Stimulation for the Treatment of Cancer Pain. Curr Pain Headache Rep 22, 11 (2018). https://doi.org/10.1007/s11916-018-0662-z

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