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Intrathecal cervical analgesia for cancer pain: a 12-year follow-up study in a comprehensive cancer center
  1. Denis Dupoiron1,
  2. Florent Bienfait1,
  3. Gabriel Carvajal2,
  4. Valerie Seegers3,
  5. Thomas Douillard1,
  6. Sabrina Jubier-Hamon1,
  7. Thierry Delorme1,
  8. Arthur Julienne1,
  9. Yves Marie Pluchon4,
  10. Nicolas Ribault5,
  11. Edmond Nader5 and
  12. Nathalie Lebrec1
  1. 1Anesthesiology and Pain Department, Institut de Cancérologie de l'Ouest, Angers, France
  2. 2Palliative Care, Costa Rica University, San Jose, San José, Costa Rica
  3. 3Epidemiology and Statistics Department, Institut de Cancerologie de l'Ouest Site Paul Papin, Angers, France
  4. 4Pain Department, Centre Hospitalier Departmental La Roche-sur-Yon, La Roche-sur-Yon, Pays de la Loire, France
  5. 5Neurosurgery Department, Centre Hospitalier Universitaire d'Angers, Angers, Pays de la Loire, France
  1. Correspondence to Dr Denis Dupoiron, Anesthesiology and Pain Department, Institut de Cancérologie de l'Ouest, Saint Herblain 44805, France; denis.dupoiron{at}


Background Intrathecal analgesia plays a key role for patients suffering refractory cancer pain. Nevertheless, intrathecal drug delivery systems (IDDS), requiring a cervical catheter tip implantation, have been poorly described in medical literature.

Aims A monocentric retrospective follow-up study was designed to evaluate results of cervical IDDS for cancer pain.

Patients and methods From January 2010 to December 2022, all intrathecal-treated patients were prescribed a combined intrathecal analgesics regimen through a catheter placed in the cervical vertebral canal. Post-implant assessment of pain was determined using a numeric rating scale (NRS). Patients were followed via day-hospital visits and telephone calls at least monthly. Pain scores were compared using the Wilcoxon’s signed rank test.

Results Ninety-eight patients were included in this study; all received intrathecal treatments. Implanted patients suffered from severe pain (mean presurgical maximum numerical rating score 8.02±0.24 despite a mean 562.56±127.72 mg of oral morphine equivalent daily dose). Mean survival time after intrathecal treatment start was 208.48±67 days. Intrathecal drug delivery systems provided pain relief compared with initial pain score with a significant statistical difference after 1 week, 1 month, 2 and 3 months (p<0.01). A 50% reduction in initial pain level was achieved in 93% of cases during the first week of intrathecal implant.

Conclusions Results suggest that long-term intrathecal treatment using a multidrug regimen for cancer-related pain through cervical intrathecal catheters was suitable and safe in our study population. We demonstrated a clinically and statistically significant pain reduction in patients using mainly a percutaneous lumbar approach.

  • cancer pain
  • facial pain
  • injections, spinal
  • neck pain

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors GC, TD, NR, VS, EN, NL, and DD participated in conceptualization and design, acquisition of data, analysis, interpretation of data and writing. AJ, FB, SJ-H, YMP and TD participated in conceptualization and analysis of data.

    DD is guarantor of the study.

  • 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 DD received consultations fees from Medtronic Esteve and Grunenthal.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.