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Intraspinal techniques for pain management in cancer patients: a systematic review

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Abstract

Purpose

This systematic review outlines current evidence regarding the effectiveness of intraspinal techniques for cancer pain and addresses practical implementation issues.

Methods

A search of electronic databases identified systematic reviews and randomized controlled trials (RCTs) evaluating the effectiveness of intraspinal techniques in the setting of cancer pain. An environmental scan was completed via the internet to identify practice guidelines and resource documents addressing organizational and implementation issues in the delivery of intraspinal analgesia. Elements reviewed included patient selection, contraindications, monitoring, aftercare, follow-up, hospital discharge equipment, health personnel, patient education, and safety.

Main results

Three systematic reviews, three consensus conferences, and 12 RCTs met the inclusion criteria for evidence of effectiveness. No single systematic review or consensus conference included all relevant RCTs or specifically addressed the use of intraspinal techniques for cancer pain. Six RCTs compared intraspinal techniques alone or combined with other interventions alone or in combination, four compared different intraspinal medications, and two compared different intraspinal techniques. In general, the evidence supported the use of intraspinal techniques for cancer pain management. The two main indications consistently identified were intractable pain not controlled by other conventional medical routes and/or side effects from conventional pain management strategies preventing dose escalation. Reports indicate intraspinal analgesia is equally or more effective than conventional medical management and often associated with fewer side effects. Thirteen resource documents addressed issues surrounding the delivery of intraspinal analgesia and program implementation.

Conclusions

Intraspinal techniques monitored by an interprofessional health care team should be included as part of a comprehensive cancer pain management program.

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Conflict of interest

The authors declared no actual or potential conflicts of interest in relation to this report.

Author information

Authors and Affiliations

  1. Palliative Care Consult Team, Odette Cancer Centre, Sunnybrook Health Sciences, Toronto, ON, Canada

    Jeff Myers

  2. Department of Anesthesia, University Health Network, Toronto, ON, Canada

    Vincent Chan

  3. The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada

    Virginia Jarvis

  4. Program in Evidence-Based Care, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada

    Cindy Walker-Dilks

Authors
  1. Jeff Myers
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  2. Vincent Chan
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  3. Virginia Jarvis
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  4. Cindy Walker-Dilks
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Correspondence to Jeff Myers.

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Myers, J., Chan, V., Jarvis, V. et al. Intraspinal techniques for pain management in cancer patients: a systematic review. Support Care Cancer 18, 137–149 (2010). https://doi.org/10.1007/s00520-009-0784-2

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  • DOI: https://doi.org/10.1007/s00520-009-0784-2

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