Retrospective Analysis of Intrathecal Drug Delivery: Outcomes, Efficacy, and Risk for Cancer-Related Pain at a High Volume Academic Medical Center

Sayed, Dawood; Monroe, Forrest; Orr, Walter N.; Phadnis, Milind A.; Khan, Talal W.; Braun, Edward; Manion, Smith; Nicol, Andrea L.

doi:10.1111/ner.12759

Cited by 28 publications

(15 citation statements)

References 19 publications

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“…Four studies (Table 1) in recent publications evaluate cohorts of cancer patients treated by IDDS for refractory pain. The largest one [14] assesses impact of IDDS in 160 patients. The median pain evaluation before implantation was 7.1 and decreased to 2.5 after 1 month and this improvement continued after 3 months.…”

Section: Recent Clinical Studiesmentioning

confidence: 99%

Intrathecal therapy for pain in cancer patients

Dupoiron¹

2019

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of reviewIntrathecal drug delivery systems (IDDS) for cancer pain remain little employed despite a high level of efficiency even though the technique is widely recommended. This review aims to summarize recent advances in IDDS for cancer patients. Recent findingsThe respective roles of catheter positioning, volume and flow rate in diffusion of intrathecal treatments, as well as the individual roles of blood pressure, heart rate, and amplitude of the respiratory movements in cerebrospinal fluid (CSF) treatment dispersion, are now well established. Models are available using MRI data. Morphine has long been the gold standard in first line treatment, but recent publications conclude that ziconotide has largely proven its efficiency and that adverse effects are controllable. Four recent publications have evaluated cohorts of cancer patients treated by IDDS in 315 patients. All found a great efficiency of intrathecal treatment for cancer pain. Technical innovations include new catheters and anchorage devices for easier placement and a lower rate of complication. Three-dimensional (3D) CT scan appears to be a noninvasive technique for the diagnosis of catheter complications. Ultrasound should be used to locate pump septum for refill. SummaryAll recent recommendations highlight the efficiency of IDDS and propose to use it sooner.

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Section: Recent Clinical Studiesmentioning

confidence: 99%

Intrathecal therapy for pain in cancer patients

Dupoiron¹

2019

Current Opinion in Supportive &Amp; Palliative Care

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“…Direct drug delivery to the spinal cord region, where receptors (gamma-aminobutyric acid (GABA), adrenergic alpha 2 (A α2), dopaminergic receptors) and calcium and sodium channels responsible for pain processing are located, without the intervention of circulatory system can greatly increase the analgesic efficacy. Though IDDS is effective in pain management, their invasiveness can result in serious complications including respiratory depression, nerve injury, spinal metastases, psychological dysfunction, local infection at the surgical site, anticoagulation, and failure of pumps necessitating novel therapeutic interventions. − …”

Section: Limitations Of Conventional Treatmentsmentioning

confidence: 99%

Scope and Applications of Nanomedicines for the Management of Neuropathic Pain

et al. 2020

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Neuropathic pain, resulting from the dysfunction of the peripheral and central nervous system, occurs in a variety of pathological conditions including trauma, diabetes, cancer, HIV, surgery, multiple sclerosis, ischemic attack, alcoholism, spinal cord damage, and many others. Despite the availability of various treatment strategies, the percentage of patients achieving adequate pain relief remains low. The clinical failure of most effective drugs is often not due to a lack of drug efficacy but due to the dose-limiting central nervous system (CNS) toxicity of the drugs that preclude dose escalation. There is a need for cross-disciplinary collaborations to meet these challenges. In this regard, the integration of nanotechnology with neuroscience is one of the most important fields. In recent years, promising preclinical research has been reported in this field. This review highlights the current challenges associated with conventional neuropathic pain treatments, the scope for nanomaterials in delivering drugs across the blood−brain barrier, and the state and prospects of nanomaterials for the management of neuropathic pain.

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“…Although the World Health Organization cancer pain ladder is extensively employed, it remains 10%–20% of cancer pain patients being inefficiently treated (Afsharimani et al., 2015 ). Intrathecal therapy (ITT), which directly delivers opioids such as morphine into the cerebrospinal fluid (CSF), has demonstrated its effectiveness on refractory cancer pain (Bhatia et al., 2013 ; De Andres et al., 2020 ; Deer et al., 2017 ; Sayed et al., 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Comparison of external system and implanted system in intrathecal therapy for refractory cancer pain in China: A retrospective study

et al. 2022

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Introduction Intrathecal therapy (ITT) via an implanted system was demonstrated for the treatment of refractory cancer pain for decades. Recently, the dissemination of ITT is enhanced in an external system way in Asia for a lower implantation cost. This study compares the efficacy, safety, and cost of the two ITT systems in refractory cancer pain patients in China. Methods One hundred and thirty‐nine cancer pain patients who underwent implantation of the ITT system were included. One hundred and three patients received ITT via the external system (external group), while 36 patients received ITT via the implanted system (implanted group). A 1:2 propensity score matching procedure was used to yield a total of 89 patients for the final analysis. Medical records of included patients were retrospectively reviewed and pain scores, incidences of complications, and costs were compared. Results ITT via the external system provided pain relief as potent as ITT via the implanted system but was less time‐consuming in the implantation phase (13 vs. 19 days, p < .01). Nausea/vomiting and urinary retention were the most frequent adverse events in both external and implanted groups (32.14%, 16.07% vs. 36.36%, 21.21%). No significant difference was found in the incidences of all kinds of complications. Compared to the implanted group, the external group cost less for the initial implantation (7268 vs. 26,275 US dollar [USD], p < .001) but had a significant higher maintenance cost (606.62 vs. 20.23 USD calculated monthly, p < .001). Conclusions ITT via the external system is as effective and safe as that via the implanted system and has the advantage of being cheap in the upfront implantation but costs more during the maintenance process in China.

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Retrospective Analysis of Intrathecal Drug Delivery: Outcomes, Efficacy, and Risk for Cancer-Related Pain at a High Volume Academic Medical Center

Abstract: IDDS has the potential to improve cancer pain in a variety of patients and should be strongly considered as an option for those with cancer pain intractable to conservative medical management.

Cited by 28 publications

References 19 publications

Intrathecal therapy for pain in cancer patients

Intrathecal therapy for pain in cancer patients

Scope and Applications of Nanomedicines for the Management of Neuropathic Pain

Comparison of external system and implanted system in intrathecal therapy for refractory cancer pain in China: A retrospective study

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