title: Intrathecal drug delivery for the management of cancer pain: a multidisciplinary consensus of best clinical practices.
abstract: A substantial number of patients with cancer suffer considerable pain at some point during their disease, and approximately 25% of cancer patients die in pain. Providing effective pain management for patients with severe pain that impacts quality of life can present the oncologist or palliative care specialist with complex clinical challenges that often require multifaceted therapeutic measures. This paper presents multidisciplinary consensus-based recommendations for the treatment of intractable cancer pain using intrathecal drug delivery systems, which offer rapid and effective pain relief with less toxicity relative to oral or parenteral administration. Intrathecal drug delivery systems can be highly effective in a variety of patient settings, including cases of refractory pain, diminished performance status, poor tolerability of oral medications, polyanalgesia for complex pain, and inadequate dosing due to addiction concerns. The use of implantable or external systems is discussed, as well as implantation procedures, drug titration recommendations, and management of potential side effects. The authors offer a newly developed algorithm for delivering intraspinal analgesia in patients with cancer. The intent is that increased understanding of available options for truly effective pain management in the oncology and palliative care arena and the benefits of multidisciplinary cooperation will translate into genuine improvements in patient quality of life and a measurable decrease in the number of patients who suffer needlessly in their final days.
authors.affiliation: Valley Cancer Pain Treatment Center, 10460 N 92nd St., Suite 300, Scottsdale, AZ 85258, USA. vcptc@aol.com
authors.forename: Lisa
authors.initials: L
authors.lastname: Stearns
authors.forename: Richard
authors.initials: R
authors.lastname: Boortz-Marx
authors.forename: Stuart
authors.initials: S
authors.lastname: Du Pen
authors.forename: Gerhard
authors.initials: G
authors.lastname: Friehs
authors.forename: Michael
authors.initials: M
authors.lastname: Gordon
authors.forename: Michelle
authors.initials: M
authors.lastname: Halyard
authors.forename: Laurel
authors.initials: L
authors.lastname: Herbst
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kiser
mesh_terms: D000698:Analgesia / Q000379:methods* / Q000592:standards; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects; D016503:Drug Delivery Systems / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D004091:Hydromorphone / Q000008:administration & dosage / Q000009:adverse effects; D015918:Infusion Pumps, Implantable / Q000009:adverse effects; D007278:Injections, Spinal; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects; D009369:Neoplasms / Q000150:complications*; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology; D018579:Patient Selection; D011183:Postoperative Complications
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D004091:Hydromorphone; D002045:Bupivacaine