Intrathecal Drug Delivery System Trialing for Cancer Pain Management

  • Namrata Khimani
  • Sanjeet Narang


Intrathecal drug delivery systems (IDDS) play an important role in cancer pain management. Early placement of IDDS in cancer patients with moderate to severe pain can improve pain control, significantly decrease side effects, and even increase life expectancy (Smith TJ, Coyne PJ, Staats PS, et al., Ann Oncol 16:825–33, 2005; Smith TJ, Staats PS, Deer T, et al., J Clin Oncol 20:4040–9). Proper patient selection is an integral component to the ultimate success of implantation, and the final criteria in the selection process are often response to a trial. While IDDS trials play an important role for patients requiring long-term therapy, the necessity of a trial in cancer patients has been questioned as cancer pain and its treatments can differ from non-cancer pain in a variety of ways. There is currently no standardized trialing technique, and no method has been shown to be superior in predicting post-implantation outcomes.


Intrathecal drug delivery system Intrathecal drug delivery system trial Trialing techniques Intrathecal drug delivery system implantation without trial Trialing techniques in cancer pain 


  1. 1.
    Smith TJ, Coyne PJ, Staats PS, et al. An implantable drug delivery system (IDDS) for refractory cancer pain provides sustained pain control, less drug-related toxicity, and possibly better survival compared with comprehensive medical management (CMM). Ann Oncol. 2005;16:825–33.CrossRefGoogle Scholar
  2. 2.
    Smith TJ, Staats PS, Deer T, et al. Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. J Clin Oncol. 2002;20:4040–9.CrossRefGoogle Scholar
  3. 3.
    Medicare Coverage Issues Manual. Coverage issues—durable medical equipment. Accessed 19 Oct 2015.
  4. 4.
    Deer TR, Prager J, Levy R, et al. Polyanalgesic Consensus Conference-2012: recommendations on trialing for intrathecal (intraspinal) drug delivery: report of an interdisciplinary expert panel. Neuromodulation. 2012;15(5):420–35.CrossRefGoogle Scholar
  5. 5.
    Yoshida GM, Nelson RW, Capen DA, Nagelberg S, Thomas JC, Rimoldi RL, Haye W. Evaluation of continuous intraspinal narcotic analgesia for chronic pain from benign causes. Am J Orthop. 1996;25:693–4.PubMedGoogle Scholar
  6. 6.
    Onofrio BM, Yaksh TL, et al. Long-term pain relief produced by intrathecal morphine infusion in 53 patients. J Neurosurg. 1990;72:200–9.CrossRefGoogle Scholar
  7. 7.
    Bolash R, Mekhail N. Intrathecal pain pumps indications, patient selection, techniques, and outcomes. Neurosurg Clin N Am. 2014;25:735–42.CrossRefGoogle Scholar
  8. 8.
    Deer TR, Smith HS, Burton AW, et al. Comprehensive consensus based guidelines on intrathecal drug delivery systems in the treatment of pain caused by cancer pain. Pain Physician. 2011;14:E283–312.PubMedGoogle Scholar
  9. 9.
    Grider JS, Harned ME, Etscheidt MA, et al. Patient selection and outcomes using a low-dose intrathecal opioid trialing method for chronic nonmalignant pain. Pain Physician. 2011;14(4):343–51.PubMedGoogle Scholar
  10. 10.
    Penn RD, Paice JA. Chronic intrathecal morphine for intractable pain. J Neurosurg. 1987;67:182–6.CrossRefGoogle Scholar
  11. 11.
    Hamza M, Doleys DM, Saleh IA, et al. A prospective, randomized, single-blinded, head-to-head long-term outcome study, comparing intrathecal (IT) boluses with continuous infusion trialing techniques prior to implantation of drug delivery systems (DDS) for the treatment of severe intractable chronic nonmalignant pain. Neuromodulation. 2015;18(7):636–48.CrossRefGoogle Scholar
  12. 12.
    Ahmed SU, Martin NM, Chang Y, et al. Patient selection and trial methods for intraspinal drug delivery for chronic pain: a national survey. Neuromodulation. 2005;8:112–20.CrossRefGoogle Scholar
  13. 13.
    Krames ES, Olson K. Clinical realities and economic considerations: patient selection in intrathecal therapy. J Pain Symptom Manag. 1997;14:S3–S13.CrossRefGoogle Scholar
  14. 14.
    Du Pen SL, Williams AR. The dilemma of conversion from systemic to epidural morphine: a proposed conversion tool for treatment of cancer pain. Pain. 1994;56:113–8.CrossRefGoogle Scholar
  15. 15.
    Malhotra VT, Root J, Kesselbrenner J, et al. Intrathecal pain pump infusions for intractable cancer pain: an algorithm for dosing without a neuraxial trial. Anesth Analg. 2013;116:1364–70.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Namrata Khimani
    • 1
  • Sanjeet Narang
    • 2
  1. 1.Department of Anesthesiology, Perioperative and Pain MedicineThe Pain Management Center at Brigham and Women’s HospitalChestnut HillUSA
  2. 2.Department of Anesthesiology, Perioperative and Pain MedicineThe Pain Management Center at Brigham and Women’s Hospital, Harvard Medical SchoolChestnut HillUSA

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