Elizabeth Roux, Alan D Kaye, Shivam S Shah, Sahar Shekoohi, David Hao
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引用次数: 0
Abstract
Purpose of review: Cancer-related pain poses a significant clinical challenge, especially in advanced stages where systemic analgesic therapies become insufficient or intolerable. Intrathecal drug delivery systems (IDDS) offer targeted pain control while minimizing systemic exposure. However, the optimal trialing approach before permanent IDDS implantation remains contentious. This narrative review examines literature on IDDS trialing strategies in cancer pain management. A comprehensive search was conducted of PubMed, MEDLINE, and Embase databases and identified studies published up to January 2025. The review included prospective and retrospective studies, randomized controlled trials, cohort studies, and case series on trialing techniques, clinical outcomes, safety, tolerability, and efficacy. Key strateghies assessed include single-shot intrathecal bolus, multiple intrathecal boluses, continuous epidural infusion, and continuous intrathecal infusion. The review found significant variability in trialing practices, with limited high-quality comparative data to support standardized protocols. Trial success criteria varied widely, encompassing pain reduction, side effects, and patient-reported outcomes.
Recent findings: The studies described a range of trialing strategies with varying durations, opioid dosages, and criteria for success. However, due to the lack of direct comparisons between these approaches, it is difficult to draw clear conclusions about the relative effectiveness of continuous intrathecal, continuous epidural, and bolus-based trials. Some institutions bypassed trialing, prioritizing symptom relief over procedural risks.
Conclusion: This review highlights the need for individualized trialing strategies based on patient status, institutional preferences, and clinician expertise. Given the variability in current practices, further research is needed to establish evidence-based guidelines and optimize clinical decision-making.
期刊介绍：
This journal aims to review the most important, recently published clinical findings regarding the diagnosis, treatment, and management of pain and headache. By providing clear, insightful, balanced contributions by international experts, the journal intends to serve all those involved in the care and prevention of pain and headache.
We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as anesthetic techniques in pain management, cluster headache, neuropathic pain, and migraine. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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