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


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.
Myers
Jeff
J
Palliative Care Consult Team, Odette Cancer Centre, Sunnybrook Health Sciences, Toronto, ON, Canada. jeff.myers@sunnybrook.ca
Chan
Vincent
V
Jarvis
Virginia
V
Walker-Dilks
Cindy
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine; D006801:Humans; D055104:Infusions, Subcutaneous; D007268:Injections, Epidural; D007278:Injections, Spinal; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010147:Pain Measurement; D010166:Palliative Care / Q000379:methods*; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
D000700:Analgesics