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Intrathecal Catheter Insertion and Analgesia is a Safe and Effective Method of Pain Control in Patients with Advanced and Intractable Cancer Pain
Chan XH Diana, Li Lydia and Tan KH
Introduction: Pain affects the quality of life in cancer patients. The World Health Organization established a simple three-step “ladder” approach in 1986, beginning with nonopioid drugs and progressing to stronger opioids as necessary. The implementation of this guideline enables analgesia to be achieved in 75% to 90% of patients. The remaining patients suffer from intractable pain requiring intrathecal analgesia. Advances in intrathecal analgesia and intrathecal drug delivery systems have allowed for a range of medications to be used in the control of pain in the remaining 20% of patients with intractable cancer pain. This technique allows for reduced medication doses that can decrease the side effects typically associated with oral or parenteral drug delivery. We aim to analyse the pain intensity before and after intrathecal analgesia and review the complications associated with the implantation and the care of the intrathecal device.
Materials and Methods: We retrospectively analysed medical records of all cancer patients whose pain were managed by intrathecal catheter implants in our centre from February 2005 to December 2014. The pain intensity was reviewed at the time prior to administration of intrathecal analgesia and at physician review prior to hospital discharge or death. Complications related to intrathecal analgesia were reviewed from the patients’ medical records.
Results: We analysed the data obtained from 44 patients. 86.4% had metastatic cancer. Pain intensity was reduced significantly at the time of discharge from hospital (P<0.001). Opioids side effects were reduced after intrathecal treatment. The main catheter-related complications were catheter displacement and infection.
Conclusion: Intrathecal catheter insertion and analgesia is a safe and effective method of pain control in patients with intractable cancer pain.