Background & Aims
The success rate of intrathecal therapy (IT) in cancer/cancer related pain is not well reported. Patient satisfaction of “Good” or “Excellent” was reported to be 59% (249/422) in benign pain by Schultz et al, and “satisfaction” in 92% by Winkelmuller & Winkelmuller. There is no published study of the success of IT preceded by epidural therapy trial for comparison. Additionally, Bruel & Burton draw attention to the need for additional research in cancer survivors’ chronic pain. The practice in our cancer center is to assess neuraxial analgesic effect with a tunneled epidural catheter for two weeks prior to the decision to implant an intrathecal pump for patients with somatic tumor pain and chronic cancer treatment related neuropathic and nociplastic pain alike. The purpose of the study is to evaluate the success rate of intrathecal drug therapy for cancer/cancer related pain after epidural therapy trial.
Methods
The study was performed by retrospective chart review. The medical record was queried for all patients who underwent intrathecal pump refill between 1/1/2012 and 1/1/2024. Chronic Pain Acceptance Questionnaire (CPAQ), treatment, and demographic data was collected for the period immediately prior epidural trial, within 6 months follow up after intrathecal pump implantation, and the last evaluation. The data was analyzed against primary outcomes of overall satisfaction/global assessment, improvement in disability and pain interference, and pain relief. Secondary outcomes are opioid utilization and adverse events. A total of 25 patients were identified. A total of 4 patients were excluded from analysis; 2 had pumps implanted before the electronic health record was created, and 2 expired prior to repeating the CPAQ. Changes in record keeping systems precluding consistent comparison of opioid usage. Unreported scores are noted in totals.
Results
Mean worst pain scores decreased from baseline 9.5 (7-10/10) to post implantation 7.4 (3-10/10) and last follow up 7.3 (3-10/10). Success in treatment scores increased; baseline 1.4 (0-4/4), implantation 2.5, (1-3/4), last follow up 2.5 (1-4/4). The global results of pain treatment over all also increased from baseline 5.3 (1-10/10) to implantation 8.2 (4-10/10), with diminished increase at last follow up 7.6 (1-10/10). No pain interference mean changed by more than +/- 0.7 points. Pain interference in sexual behavior was the most frequently omitted survey item, absent 38% of the time. At baseline 33% (6/18) reported overall satisfaction of 7-10/10, 95% (19/20) post implantation, and 68%(13/19) at last follow up; last follow up scores diverged between deceased (mean 6.1) and living (mean 8.4) groups. Amount of pain you can live with increased; baseline 2.9 (0-8/10), post implant 3.2 (0-6/10), follow up 3.3 (0-8/10). There was one adverse event, a granuloma which resolved.
Conclusions
IT can effectively decrease pain scores associated with tumor in cancer patients and in cancer survivors with neuropathic and nociplastic pain. IT also increased self-reported sense of success in treatment and satisfaction of analgesia in this group. Serious adverse events are very uncommon to rare. Patient selection remains critically important.
References
Schultz DM, Orhurhu V, Khan F, Hagedorn JM, Abd-Elsayed A. Patient Satisfaction Following Intrathecal Targeted Drug Delivery for Benign Chronic Pain: Results of a Single-Center Survey Study. Neuromodulation. 2020 Oct;23(7):1009-1017. doi: 10.1111/ner.13167. Epub 2020 May 6. PMID: 32378289; PMCID: PMC7687151.
Winkelmüller M, Winkelmüller W. Long-term effects of continuous intrathecal opioid treatment in chronic pain of nonmalignant etiology. Journal of Neurosurgery. 1996;85(3):458-467. doi:10.3171/jns.1996.85.3.0458
Brian M. Bruel, Allen W. Burton, Intrathecal Therapy for Cancer-Related Pain, Pain Medicine, Volume 17, Issue 12, December 2016, Pages 2404–2421, https://doi.org/10.1093/pm/pnw060
Presenting Author
Benjamin Matson
Poster Authors
Benjamin Matson
MD
Roswell Park Comprehensive Cancer Center
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Cancer Pain & Palliative Care