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Evaluation of intrathecal drug delivery system for intractable pain in advanced malignancies: A prospective cohort study
Pain is prevalent in advanced malignancies; however, some patients cannot get adequate pain relief by conservative routes of analgesic administration or experience serious side effects related to high dose of opioids. For those who have exhausted multimodal conservative analgesic, intrathecal drug d...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5369925/ https://www.ncbi.nlm.nih.gov/pubmed/28296770 http://dx.doi.org/10.1097/MD.0000000000006354 |
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author | Zheng, Shuyue He, Liangliang Yang, Xiaohui Li, Xiuhua Yang, Zhanmin |
author_facet | Zheng, Shuyue He, Liangliang Yang, Xiaohui Li, Xiuhua Yang, Zhanmin |
author_sort | Zheng, Shuyue |
collection | PubMed |
description | Pain is prevalent in advanced malignancies; however, some patients cannot get adequate pain relief by conservative routes of analgesic administration or experience serious side effects related to high dose of opioids. For those who have exhausted multimodal conservative analgesic, intrathecal drug delivery is an alternative intervention for truly effective pain management. The objective of this study was to evaluate the clinical efficacy and safety of intrathecal drug delivery system (IDDS) for the treatment of intractable pain in advanced cancer patients. A prospective cohort study was performed between July 2015 and October 2016. Fifty-three patients undergoing intractable cancer-related pain or intolerable drug-related adverse effects were recruited and received IDDS therapy with a patient-controlled intrathecal analgesia pump. The assessment was conducted during admission, in titration period, and followed up monthly to death by scheduled refill visits. Pain numeric rating scale scores, comprehensive toxicity scores, quality of life scores, systemic opioid use (basal and breakthrough dose), intrathecal morphine use (basal and patient-controlled intrathecal analgesia dose), and complications were recorded to evaluate the curative effect and safety. Between baseline and all subsequent follow-ups, statistically significant decreases in pain numeric rating scale scores and comprehensive toxicity scores were verified. A statistical improvement in quality of life scores was found after starting IDDS therapy. Both basal and breakthrough doses of systemic opioid showed a significant decrease during the follow-up period. And there was a modest escalation in the intrathecal morphine dose throughout the duration of study. No infective, device-related, and catheter-related complications were observed. The findings showed that IDDS therapy allowed for rapid and highly effective pain relief with less toxicity in comparison to conservative medications. Patients with advanced malignancies would also benefit from an improvement in the life quality after the procedure. IDDS therapy represented a valuable option for intractable cancer-related pain management. |
format | Online Article Text |
id | pubmed-5369925 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-53699252017-03-31 Evaluation of intrathecal drug delivery system for intractable pain in advanced malignancies: A prospective cohort study Zheng, Shuyue He, Liangliang Yang, Xiaohui Li, Xiuhua Yang, Zhanmin Medicine (Baltimore) 3700 Pain is prevalent in advanced malignancies; however, some patients cannot get adequate pain relief by conservative routes of analgesic administration or experience serious side effects related to high dose of opioids. For those who have exhausted multimodal conservative analgesic, intrathecal drug delivery is an alternative intervention for truly effective pain management. The objective of this study was to evaluate the clinical efficacy and safety of intrathecal drug delivery system (IDDS) for the treatment of intractable pain in advanced cancer patients. A prospective cohort study was performed between July 2015 and October 2016. Fifty-three patients undergoing intractable cancer-related pain or intolerable drug-related adverse effects were recruited and received IDDS therapy with a patient-controlled intrathecal analgesia pump. The assessment was conducted during admission, in titration period, and followed up monthly to death by scheduled refill visits. Pain numeric rating scale scores, comprehensive toxicity scores, quality of life scores, systemic opioid use (basal and breakthrough dose), intrathecal morphine use (basal and patient-controlled intrathecal analgesia dose), and complications were recorded to evaluate the curative effect and safety. Between baseline and all subsequent follow-ups, statistically significant decreases in pain numeric rating scale scores and comprehensive toxicity scores were verified. A statistical improvement in quality of life scores was found after starting IDDS therapy. Both basal and breakthrough doses of systemic opioid showed a significant decrease during the follow-up period. And there was a modest escalation in the intrathecal morphine dose throughout the duration of study. No infective, device-related, and catheter-related complications were observed. The findings showed that IDDS therapy allowed for rapid and highly effective pain relief with less toxicity in comparison to conservative medications. Patients with advanced malignancies would also benefit from an improvement in the life quality after the procedure. IDDS therapy represented a valuable option for intractable cancer-related pain management. Wolters Kluwer Health 2017-03-24 /pmc/articles/PMC5369925/ /pubmed/28296770 http://dx.doi.org/10.1097/MD.0000000000006354 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nd/4.0 This is an open access article distributed under the Creative Commons Attribution-NoDerivatives License 4.0, which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author. http://creativecommons.org/licenses/by-nd/4.0 |
spellingShingle | 3700 Zheng, Shuyue He, Liangliang Yang, Xiaohui Li, Xiuhua Yang, Zhanmin Evaluation of intrathecal drug delivery system for intractable pain in advanced malignancies: A prospective cohort study |
title | Evaluation of intrathecal drug delivery system for intractable pain in advanced malignancies: A prospective cohort study |
title_full | Evaluation of intrathecal drug delivery system for intractable pain in advanced malignancies: A prospective cohort study |
title_fullStr | Evaluation of intrathecal drug delivery system for intractable pain in advanced malignancies: A prospective cohort study |
title_full_unstemmed | Evaluation of intrathecal drug delivery system for intractable pain in advanced malignancies: A prospective cohort study |
title_short | Evaluation of intrathecal drug delivery system for intractable pain in advanced malignancies: A prospective cohort study |
title_sort | evaluation of intrathecal drug delivery system for intractable pain in advanced malignancies: a prospective cohort study |
topic | 3700 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5369925/ https://www.ncbi.nlm.nih.gov/pubmed/28296770 http://dx.doi.org/10.1097/MD.0000000000006354 |
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