Bruel, B.M., & Burton, A.W. (2016). Intrathecal therapy for cancer-related pain. Pain Medicine, 17, 2404–2421.

STUDY PURPOSE: Summarize the evidence regarding use of intrathecal therapy for management of cancer-related pain.

TYPE OF STUDY: Systematic review

DATABASES USED: MEDLINE

INCLUSION CRITERIA: Use of intrathecal approach for pain management

EXCLUSION CRITERIA: Not stated

TOTAL REFERENCES RETRIEVED: 231

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: 2 RCTs and 8 observational studies were included. Method for quality evaluation not reported

FINAL NUMBER STUDIES INCLUDED: 10 

TOTAL PATIENTS INCLUDED IN REVIEW: 807

SAMPLE RANGE ACROSS STUDIES: 22 to 200

KEY SAMPLE CHARACTERISTICS: All had refractory pain

Duration of follow-up ranged from 11 days to up to 16 months. Comparison of those treated with conventional medical management versus implanted intrathecal drug delivery showed significantly reduced pain scores among implanted patients (p = 0.007) across all studies. Both morphine and zicontide demonstrated efficacy.

Intrathecal pain management is shown to be effective in patients with refractory cancer-related pain.

• Limited search
• Limited number of studies included
• No quality evaluation

Intrathecal delivery of pain medication is shown to be effective in patients with refractory pain. The decision to implant an intrathecal drug delivery device needs to be based on weighing benefits for pain control against risks from surgery, drug management issues, and against other palliative care options