Advertisement

A 65-Year-Old Man with Poor Cancer Pain Control Despite Intrathecal Pump

  • Tariq MalikEmail author
Chapter
  • 37 Downloads

Abstract

Cancer is a public healthcare problem and is the second leading cause of death in the United States. Cancer pain occurs in varying degrees depending on the disease stage, type of cancer, and location where 75% of cancer patients will complain of pain at some stage of their disease (Bao et al., Cochrane Database Syst Rev 10:CD011108, 2016). Intrathecal pump (ITP) was first reported as an effective cancer pain treatment modality in 1981 (Onofrio et al., Mayo Clin Proc 56(8):516–520, 1981; Wang et al., Anesthesiology 50(2):149–151, 1979). Advances in technology over the past 30 years have rendered ITP as an effective modality for treating intractable cancer pain; however, this modality requires sufficient knowledge and expertise for implantation and management. We will discuss some of the important aspects of ITP therapy in cancer pain patients, factors to consider in case of poor pain control in previously stable patients with ITP therapy thus avoiding long-term serious complications.

Keywords

Intrathecal pump Cancer pain Complications of cancer Pain control in cancer Refractory cancer pain 

References

  1. 1.
    Bao YJ, et al. Hydromorphone for cancer pain. Cochrane Database Syst Rev. 2016;10:CD011108.PubMedGoogle Scholar
  2. 2.
    Onofrio BM, Yaksh TL, Arnold PG. Continuous low-dose intrathecal morphine administration in the treatment of chronic pain of malignant origin. Mayo Clin Proc. 1981;56(8):516–20.PubMedGoogle Scholar
  3. 3.
    Wang JK, Nauss LA, Thomas JE. Pain relief by intrathecally applied morphine in man. Anesthesiology. 1979;50(2):149–51.CrossRefGoogle Scholar
  4. 4.
    Neufeld NJ, Elnahal SM, Alvarez RH. Cancer pain: a review of epidemiology, clinical quality and value impact. Future Oncol. 2017;13(9):833–41.CrossRefGoogle Scholar
  5. 5.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67(1):7–30.CrossRefGoogle Scholar
  6. 6.
    Yaksh TL, Rudy TA. Analgesia mediated by a direct spinal action of narcotics. Science. 1976;192(4246):1357–8.CrossRefGoogle Scholar
  7. 7.
    Smith TJ, et al. Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. J Clin Oncol. 2002;20(19):4040–9.CrossRefGoogle Scholar
  8. 8.
    Stearns LJ, et al. Health services utilization and payments in patients with cancer pain: a comparison of intrathecal drug delivery vs conventional medical management. Neuromodulation. 2016;19(2):196–205.CrossRefGoogle Scholar
  9. 9.
    Onofrio BM, Yaksh TL. Long-term pain relief produced by intrathecal morphine infusion in 53 patients. J Neurosurg. 1990;72(2):200–9.CrossRefGoogle Scholar
  10. 10.
    Winkelmuller M, Winkelmuller W. Long-term effects of continuous intrathecal opioid treatment in chronic pain of nonmalignant etiology. J Neurosurg. 1996;85(3):458–67.CrossRefGoogle Scholar
  11. 11.
    Pucks-Faes E, et al. Eleven years’ experience with intrathecal baclofen – complications, risk factors. Brain Behav. 2018;8(5):e00965.CrossRefGoogle Scholar
  12. 12.
    Deer TR. A prospective analysis of intrathecal granuloma in chronic pain patients: a review of the literature and report of a surveillance study. Pain Physician. 2004;7(2):225–8.PubMedGoogle Scholar
  13. 13.
    Duarte RV, et al. Intrathecal granuloma formation as result of opioid delivery: systematic literature review of case reports and analysis against a control group. Clin Neurol Neurosurg. 2012;114(6):577–84.CrossRefGoogle Scholar
  14. 14.
    Shields DC, et al. Extramedullary intrathecal catheter granuloma adherent to the conus medullaris presenting as cauda equina syndrome. Anesthesiology. 2005;102(5):1059–61.CrossRefGoogle Scholar
  15. 15.
    Motta F, Antonello CE. Analysis of complications in 430 consecutive pediatric patients treated with intrathecal baclofen therapy: 14-year experience. J Neurosurg Pediatr. 2014;13(3):301–6.CrossRefGoogle Scholar
  16. 16.
    Kleinmann B, Wolter T. Intrathecal opioid therapy for non-malignant chronic pain: a long-term perspective. Neuromodulation. 2017;20(7):719–26.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Anesthesia and Critical Care University of ChicagoChicagoUSA

Personalised recommendations