Management of Refractory Cancer Pain with Intrathecal Drug Delivery and Spinal Cord Stimulation.

IF 1.1 Q4 HEALTH CARE SCIENCES & SERVICES

Palliative medicine reports Pub Date : 2024-08-02 eCollection Date: 2024-01-01 DOI:10.1089/pmr.2023.0089

Evgeny Bulat, Jason E Crowther, Vikram Chakravarthy, Ilya Laufer, Ori Barzilai, Amitabh Gulati

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Abstract

Background: Intrathecal pumps (ITPs) are indicated for refractory cancer pain and decrease systemic opioid requirements. While not yet indicated for cancer pain, spinal cord stimulators (SCSs) are used off-label for cancer pain, with increasing evidence of their efficacy.

Materials and methods: A retrospective chart review was conducted of patients who underwent both ITP and at least SCS trial for cancer pain. Primary outcomes were pain numeric rating scale (NRS) and daily morphine equivalents (MEQs).

Results: Seventeen patients were identified. Both ITP and SCS were associated with significant decreases in pain ratings at the 3-month follow-up, but this decrease became nonsignificant subsequently. ITP, but not SCS, was associated with a significant decrease in MEQ.

Conclusions: ITP and SCS may both provide efficacy for cancer pain, but the opioid-sparing effects of SCS may be limited. ITP and SCS may potentially be complementary in their ability to provide relief from cancer-related pain.

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通过鞘内给药和脊髓刺激治疗难治性癌症疼痛

背景：鞘内泵（ITPs）适用于难治性癌痛，可减少全身对阿片类药物的需求。脊髓刺激器（SCS）虽然尚未用于癌痛，但已在标签外用于癌痛，越来越多的证据显示了其疗效：对既接受过 ITP 治疗又至少接受过 SCS 治疗的癌痛患者进行了回顾性病历审查。主要结果为疼痛数字评分量表（NRS）和每日吗啡当量（MEQs）：结果：确定了 17 名患者。在 3 个月的随访中，ITP 和 SCS 均使疼痛评分显著下降，但随后这种下降变得不显著。ITP与MEQ的显著下降有关，但与SCS无关：结论：ITP 和 SCS 均可有效治疗癌症疼痛，但 SCS 的阿片类药物节约效果可能有限。ITP和SCS在缓解癌症相关疼痛方面可能具有互补性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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