Spinal analgesia in cancer pain management-MASCC general practice recommendations
Abstract
Patients with cancer pain refractory to conventional medical management may benefit from spinal analgesia, although there are some critical points regarding some aspects which cannot be examined by an evidence-based approach. A group of experts was selected by MASSC to provide clinical practice advice on the use of spinal drug delivery in patients with cancer-related pain. Refractory cancer pain should be considered a condition in which a patient has failed to receive adequate analgesia or has developed uncontrolled side effects after comprehensive pain management. The intrathecal route (IT) with an implantable drug delivery system allows the administration of minimal doses of analgesics with significant clinical effects while avoiding major adverse effects and lower risks with prolonged use. Morphine and hydromorphone are the opioids of choice for IT treatment. Local anesthetics are an added value because of their additive-synergic effect on segmental areas. The efficacy of adding small amounts of local anesthetics to an ITDD relies on the positioning of the tip of the catheter close to the dermatome where the origin of the pain comes from. Their use, however, depends on the delivery system, because larger volumes are necessary. Ziconotide requires a slow dose titration, but it can be used in small volumes. In addition, once doses are stabilized, no tolerance occurs. A conversion ratio of 100:1 between oral and IT morphine is suggested for patients who receive high doses of…
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