title: A report on the consequences of the first implanted device for long-term analgesia in refractory cancer pain.
abstract: BACKGROUND
  During the early 1970s, satisfactory long-term treatment of the severe pain associated with metastatic cancer was not available. Spinal cord stimulation introduced a few years earlier in 1967 had not proven to be effective in treating nociceptive pain. We describe our pioneering experience using an implanted device to infuse local anesthetics into the epidural space and provide pain relief to the patient.
  
  
  METHODS
  Increasing doses of systemic opioids were unsuccessful in treating the intractable pain of spinal metastases in our patient. We devised an analgesic delivery system by modifying equipment usually used for ventriculoperitoneal shunts. A lumbar epidural catheter was inserted in the patient's spine, then tunneled subcutaneously across the flank to the anterior abdominal wall, and subsequently connected to a modified Ommaya reservoir with ventriculoperitoneal shunt tubing. This was filled with local anesthetic and injected into the patient's epidural space by manual compression.
  
  
  RESULTS
  The system was used for several months with intermittent addition of local anesthetic to the reservoir with satisfactory control of the patient's pain.
  
  
  CONCLUSIONS
  We describe the first use of an implanted epidural catheter system for long-term relief of pain due to terminal cancer that occurred at Peter Bent Brigham Hospital in Boston. We contend that this event played an important role in the cascade of devices that followed and connect it to the changes in the attitude of health care providers toward treatment of cancer pain.
authors.affiliation: Department of Anaesthesia, Harvard Medical School, Boston, MA; Brigham and Women's Hospital (formerly Peter Bent Brigham Hospital), Boston, MA.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Pilon
authors.affiliation: Department of Anaesthesia, Harvard Medical School, Boston, MA; Brigham and Women's Hospital (formerly Peter Bent Brigham Hospital), Boston, MA.
authors.forename: Sanjeet
authors.initials: S
authors.lastname: Narang
authors.affiliation: Department of Anaesthesia, Harvard Medical School, Boston, MA; Brigham and Women's Hospital (formerly Peter Bent Brigham Hospital), Boston, MA. Electronic address: sdesai@partners.org.
authors.forename: Sukumar P
authors.initials: SP
authors.lastname: Desai
mesh_terms: D015360:Analgesia, Epidural / Q000295:instrumentation* / Q000523:psychology; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D000072716:Cancer Pain / Q000188:drug therapy*; D004333:Drug Administration Routes; D005260:Female; D006801:Humans; D008875:Middle Aged; D059408:Pain Management / Q000295:instrumentation* / Q000379:methods / Q000523:psychology; D010148:Intractable Pain / Q000188:drug therapy* / Q000523:psychology; D017060:Patient Satisfaction; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local
keywords: Cancer pain; Implanted epidural catheter system; Long-term analgesia