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Controversies in intrathecal drug delivery for cancer pain
  1. Shane E Brogan1,
  2. Jill E Sindt1,
  3. Daniel W Odell1,
  4. Amitabh Gulati2 and
  5. Denis Dupoiron3
  1. 1Department of Anesthesiology, University of Utah Health, Salt Lake City, Utah, USA
  2. 2Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  3. 3Department of Anesthesia and Pain Medicine, Institut de Cancerologie de l'Ouest Site Paul Papin, Angers, France
  1. Correspondence to Dr Shane E Brogan, Anesthesiology, University of Utah Health, Salt Lake City, UT 84132, USA; SHANE.BROGAN{at}HSC.UTAH.EDU

Abstract

Pain and suffering related to cancer are challenging issues that continue to deserve consideration for treatment optimization. Advances in analgesic management and control of the underlying cancer have improved symptom management, yet many patients still suffer from uncontrolled pain. Intrathecal drug delivery has an established role in the management of refractory cancer pain, but there are significant knowledge gaps in our understanding and application of this therapy. This review addresses several areas of controversy, including the importance of intrathecal catheter tip location, the necessity of an intrathecal trial and the role of intrathecal ziconotide and local anesthetics. In each area, the evidence is discussed, with an emphasis on presenting practical clinical guidance and highlighting deficiencies in our knowledge that are worthy of future investigation.

  • Analgesics, Opioid
  • Anesthesia, Local
  • Pharmacology
  • Cancer Pain

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Footnotes

  • Twitter @ShaneBrogan9

  • Contributors SEB is responsible for the overall content as guarantor. SEB, JES and DWO were involved in manuscript design. All authors were involved in manuscript preparation. All authors approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SEB serves as a consultant for Medtronic, Inc. JES serves as a consultant for Medtronic, Inc. DWO has no conflicts of interest. AG serves as an advisor for Medtronic, Flowonix, SPR therapeutics, Nalu medical, Hinge health, Rivanna Medical, Nalu Medical and Maxwell Therapeutics and has options in SPR therapeutics and Hinge Health and Maxwell therapeutics. DD has served as a consultant for Medtronic and Riemser.

  • Provenance and peer review Not commissioned; externally peer reviewed.