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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 2/2014

01.02.2014 | Review Article/Brief Review

Brief review: Neuraxial analgesia in refractory malignant pain

verfasst von: Catherine E. Smyth, MD, PhD, Virginia Jarvis, RN, Patricia Poulin, PhD

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 2/2014

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Abstract

Purpose

This narrative review aims to inform health care practitioners of the current literature surrounding the use of intrathecal (IT) and epidural analgesia in cancer patients with refractory pain at end of life. Topics discussed and reviewed include: patient selection, treatment planning, procedure, equipment, medications, complications, policies and procedures, as well as directions for future research.

Principal findings

Cancer pain is inadequately treated in an estimated 10% of patients with malignant pain despite the implementation of the World Health Organization three-step analgesic ladder. This has prompted some to advocate for the addition of a fourth step that would include neuraxial interventions. There is moderate evidence supporting the safety and efficacy of IT drug therapy in cancer patients with refractory pain. A detailed assessment and interdisciplinary team approach is necessary to develop and implement care plans for patients requiring neuraxial analgesia. Neuraxial analgesia can significantly improve pain and reduce side effects, but this must be balanced against the increased complexity of care and the risk of uncommon but serious complications.

Conclusion

Neuraxial drug delivery gives clinicians more options to manage refractory pain at end of life and should be offered to patients with intractable cancer pain. Teams should be interprofessional with clear delineation of roles and responsibilities. They should discuss advanced discharge planning with the patient prior to implantation as well as provide on-call support.
Fußnoten
Literatur
1.
Rathbone GV, Horsley S, Goacher J. A self-evaluated assessment suitable for seriously ill hospice patients. Palliat Med 1994; 8: 29-34.PubMedCrossRef
2.
Deandrea S, Montanari M, Moja L, Apolone G. Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol 2008; 19: 1985-91.PubMedCrossRef
3.
4.
Vargas-Schaffer G. Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician 2010; 56: 514-7.PubMedCentralPubMed
5.
Ferreira KA, Kimura M, Teixeira MJ. The WHO analgesic ladder for cancer pain control, twenty years of use. How much pain relief does one get from using it? Support Care Cancer 2006; 14: 1086-93.
6.
7.
Smith TJ, Staats PS, Deer T, et al. Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. J Clin Oncol 2002; 20: 4040-9.PubMedCrossRef
8.
Nicholson AB. Methadone for cancer pain. Cochrane Database Syst Rev 2007; 4: CD003971.
9.
Kurita GP, Kaasa S, Sjogren P, European Palliative Care Research Collaborative (EPCRC). Spinal opioids in adult patients with cancer pain: a systematic review: a European Palliative Care Research Collaborative (EPCRC) opioid guidelines project. Palliat Med 2011; 25: 560-77.PubMedCrossRef
10.
Deer T, Smith HS, Burton AW, et al. Comprehensive consensus based guidelines on intrathecal drug delivery systems in the treatment of pain caused by cancer pain. Pain Physician 2011; 14: E283-312.PubMed
11.
Canadian Cancer Society, Statistics Canada. Canadian Cancer Statistics 2012. Provincial/Territorial Cancer Registries, Public Health Agency of Canada. Toronto; 2012; 1-69.
12.
Ploghaus A, Narain C, Beckmann CF, et al. Exacerbation of pain by anxiety is associated with activity in a hippocampal network. J Neurosci 2001; 21: 9896-903.PubMed
13.
Klauenberg S, Maier C, Assion HJ, et al. Depression and changed pain perception: hints for a central disinhibition mechanism. Pain 2008; 140: 332-43.PubMedCrossRef
14.
Kachuri L, De P, Ellison LF, Semenciw R; Advisory Committee on Canadian Cancer Statistics. Cancer incidence, mortality and survival trends in Canada, 1970-2007. Chronic Dis Inj Can 2013; 33: 69-80.
15.
Vallerand AH, Collins-Bohler D, Templin T, Hasenau SM. Knowledge of and barriers to pain management in caregivers of cancer patients receiving homecare. Cancer Nurs 2007; 30: 31-7.PubMedCrossRef
16.
Lemay K, Wilson KG, Buenger U, et al. Fear of pain in patients with advanced cancer or in patients with chronic noncancer pain. Clin J Pain 2011; 27: 116-24.PubMedCrossRef
17.
Van Dongen RT, Crul BJ, De Bock M. Long-term intrathecal infusion of morphine and morphine/bupivacaine mixtures in the treatment of cancer pain: a retrospective analysis of 51 cases. Pain 1993; 55: 119-23.PubMedCrossRef
18.
van Dongen RT, Crul BJ, van Egmond J. Intrathecal coadministration of bupivacaine diminishes morphine dose progression during long-term intrathecal infusion in cancer patients. Clin J Pain 1999; 15: 166-72.PubMedCrossRef
19.
Rosenfeld DM, Trentman T, Patel NP. Pontine hemorrhage following a recently implanted intrathecal drug delivery system. Pain Pract 2009; 9: 312-6.PubMedCrossRef
20.
van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol 2007; 18: 1437-49.
21.
Fainsinger RL, Nekolaichuk C, Lawlor P, et al. An international multicentre validation study of a pain classification system for cancer patients. Eur J Cancer 2010; 46: 2896-904.PubMedCrossRef
22.
Fainsinger RL, Fairchild A, Nekolaichuk C, Lawlor P, Lowe S, Hanson J. Is pain intensity a predictor of the complexity of cancer pain management? J Clin Oncol 2009; 27: 585-90.PubMedCrossRef
23.
Mercadante S. Controversies over spinal treatment in advanced cancer patients. Support Care Cancer 1998; 6: 495-502.PubMedCrossRef
24.
Appelgren L, Nordborg C, Sjoberg M, Karlsson PA, Nitescu P, Curelaru I. Spinal epidural metastasis: implications for spinal analgesia to treat “refractory” cancer pain. J Pain Symptom Manage 1997; 13: 25-42.PubMedCrossRef
25.
Mercadante S. Opioid rotation for cancer pain: rationale and clinical aspects. Cancer 1999; 86: 1856-66.PubMedCrossRef
26.
Indelicato RA, Portenoy RK. Opioid rotation in the management of refractory cancer pain. J Clin Oncol 2002; 20: 348-52.PubMed
27.
Horlocker TT, Wedel DJ, Rowlingson JC, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med 2010; 35: 64-101.PubMedCrossRef
28.
Anderson SL, Shreve ST. Continuous subcutaneous infusion of opiates at end-of-life. Ann Pharmacother 2004; 38: 1015-23.PubMedCrossRef
29.
Reddy A, Hui D, Bruera E. A successful palliative care intervention for cancer pain refractory to intrathecal analgesia. J Pain Symptom Manage 2012; 44: 124-30.PubMedCrossRef
30.
Mercadante S, Intravaia G, Villari P, et al. Intrathecal treatment in cancer patients unresponsive to multiple trials of systemic opioids. Clin J Pain 2007; 23: 793-8.PubMedCrossRef
31.
Challapalli V, Tremont-Lukats IW, McNicol ED, Lau J, Carr DB. Systemic administration of local anesthetic agents to relieve neuropathic pain. Cochrane Database Syst Rev 2005; 4: CD003345.
32.
Chua NH, van Dongen R, Vissers KC. Intrathecal analgesia for cancer pain: externalised intrathecal catheters. Ann Acad Med Singapore 2010; 39: 879-80.PubMed
33.
McCleane G. Intravenous lidocaine: an outdated or underutilized treatment for pain? J Palliat Med 2007; 10: 798-805.PubMedCrossRef
34.
Mercadante S, Villari P, Ferrera P, Arcuri E. Local anesthetic switching for intrathecal tachyphylaxis in cancer patients with pain. Anesth Analg 2003; 97: 187-9.PubMedCrossRef
35.
Wu H, Wang D. Radiation-induced alarm and failure of an implanted programmable intrathecal pump. Clin J Pain 2007; 23: 826-8.PubMedCrossRef
36.
Prommer EE. Ketamine for pain: an update of uses in palliative care. J Palliat Med 2012; 15: 474-83.PubMedCrossRef
37.
Ballantyne JC, Carwood CM. Comparative efficacy of epidural, subarachnoid, and intracerebroventricular opioids in patients with pain due to cancer. Cochrane Database Syst Rev 2005; 1: CD005178.
38.
Rauck RL. Intraspinal therapy in the management of refractory cancer pain. Techniques in Regional Anesthesia and Pain Management 1997; 1: 38-46.CrossRef
39.
Stearns L, Boortz-Marx R, DuPen S, et al. Intrathecal drug delivery for the management of cancer pain: a multidisciplinary consensus of best clinical practices. J Support Oncol 2005; 3: 399-408.PubMed
40.
Hawley P, Beddard-Huber E, Grose C, McDonald W, Lobb D, Malysh L. Intrathecal infusions for intractable cancer pain: a qualitative study of the impact on a case series of patients and caregivers. Pain Res Manag 2009; 14: 371-9.PubMedCentralPubMed
41.
Arcidiacono PG, Calori G, Carrara S, McNicol ED, Testoni PA. Celiac plexus block for pancreatic cancer pain in adults. Cochrane Database Syst Rev 2011; 3: CD007519.
42.
Harsh V, Viswanathan A. Surgical/radiological interventions for cancer pain. Curr Pain Headache Rep 2013; 17: 331.PubMedCrossRef
43.
Miguel R. Interventional treatment of cancer pain: the fourth step in the World Health Organization analgesic ladder? Cancer Control 2000; 7: 149-56.PubMed
44.
Knight KH, Brand FM, Mchaourab AS, Veneziano G. Implantable intrathecal pumps for chronic pain: highlights and updates. Croat Med J 2007; 48: 22-34.PubMedCentralPubMed
45.
Kim JH, Jung JY, Cho MS. Continuous intrathecal morphine administration for cancer pain management using an intrathecal catheter connected to a subcutaneous injection port: a retrospective analysis of 22 terminal cancer patients in Korean population. Korean J Pain 2013; 26: 32-8.PubMedCentralPubMedCrossRef
46.
Farquhar-Smith P, Chapman S. Neuraxial (epidural and intrathecal) opioids for intractable pain. Br J Pain 2012; 6: 25-35.CrossRef
47.
Pasutharnchat K, Tan KH, Hadi MA, Ho KY. Intrathecal analgesia in patients with cancer pain – an audity in a tertiary institution. Ann Acad Med Singapore 2009; 38: 943-6.PubMed
48.
Myers J, Chan V, Jarvis V, Walker-Dilks C. Intraspinal techniques for pain management in cancer patients: a systematic review. Support Care Cancer 2010; 18: 137-49.PubMedCrossRef
49.
Hayek SM, Deer TR, Pope JE, Panchal SJ, Patel VB. Intrathecal therapy for cancer and non-cancer pain. Pain Physician 2011; 14: 219-48.PubMed
50.
Grady K, Raphael JH. Intrathecal drug delivery for the management of pain and spasticity in adults; recommendations for best clinical practice. 2008; 1-40.
51.
Myers J, Chan V, Jarvis V, Walker-Dilks C, Palliative Care Clinical Program. Intraspinal techniques for pain management in cancer patients. Cancer Care Ontario: Program in Evidence-Based Care 2009: 1-56.
52.
Ripamonti CI, Santini D, Maranzano E, Berti M, Roila F; ESMO Guidelines Working Group. Management of cancer pain: ESMO Clinical Practice Guidelines. Ann Oncol 2012; 23 Suppl 7: vii139-54.
53.
Anghelescu DL, Faughnan LG, Baker JN, Yang J, Kane JR. Use of epidural and peripheral nerve blocks at the end of life in children and young adults with cancer: the collaboration between a pain service and a palliative care service. Paediatr Anaesth 2010; 20: 1070-7.PubMedCrossRef
54.
Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 1991; 7: 6-9.PubMed
55.
Watanabe SM, Nekolaichuk C, Beaumont C, Johnson L, Myers J, Strasser F. A multicenter study comparing two numerical versions of the Edmonton Symptom Assessment System in palliative care patients. J Pain Symptom Manage 2011; 41: 456-68.PubMedCrossRef
56.
Philip J, Smith WB, Craft P, Lickiss N. Concurrent validity of the modified Edmonton Symptom Assessment System with the Rotterdam Symptom Checklist and the Brief Pain Inventory. Support Care Cancer 1998; 6: 539-41.PubMedCrossRef
57.
Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S. The prevalence of psychological distress by cancer site. Psychooncology 2001; 10: 19-28.PubMedCrossRef
58.
Broghan SE, Winter NB. Patient-controlled intrathecal analgesia for the management of breakthrough cancer pain: a retrospective review and commentary. Pain Med 2011; 12: 1758-68.CrossRef
59.
Ummenhofer WC, Arends RH, Shen DD, Bernards CM. Comparative spinal distribution and clearance kinetics of intrathecally administered morphine, fentanyl, alfentanil, and sufentanil. Anesthesiology 2000; 92: 739-53.PubMedCrossRef
60.
Sjoberg M, Appelgren L, Einarsson S, et al. Long-term intrathecal morphine and bupivacaine in “refractory” cancer pain. I. Results from the first series of 52 patients. Acta Anaesthesiol Scand 1991; 35: 30-43.PubMedCrossRef
61.
Sjoberg M, Nitescu P, Appelgren L, Curelaru I. Long-term intrathecal morphine and bupivacaine in patients with refractory cancer pain. Results from a morphine:bupivacaine dose regimen of 0.5:4.75 mg/ml. Anesthesiology 1994; 80: 284-97.PubMedCrossRef
62.
Coombs DW, Saunders RL, Fratkin JD, Jensen LE, Murphy CA. Continuous intrathecal hydromorphone and clonidine for intractable cancer pain. J Neurosurg 1986; 64: 890-4.PubMedCrossRef
63.
van Essen EJ, Bovill JG, Ploeger EJ, Beerman H. Intrathecal morphine and clonidine for control of intractable cancer pain. A case report. Acta Anaesthesiol Belg 1988; 39: 109-12.PubMed
64.
Smith HS, Deer TR, Staats PS, Singh V, Sehgal N, Cordner H. Intrathecal drug delivery. Pain Physician 2008; 11(2 Suppl): S89-104.PubMed
65.
Miljanich GP, Ramachandran J. Antagonists of neuronal calcium channels: structure, function, and therapeutic implications. Annu Rev Pharmacol Toxicol 1995; 35: 707-34.PubMedCrossRef
66.
Olivera BM. Conus peptides: biodiversity-based discovery and exogenomics. J Biol Chem 2006; 281: 31173-7.PubMedCrossRef
67.
Staats PS, Yearwood T, Charapata SG, et al. Intrathecal ziconotide in the treatment of refractory pain in patients with cancer or AIDS: a randomized controlled trial. JAMA 2004; 291: 63-70.PubMedCrossRef
68.
Deer TR, Prager J, Levy R, et al. Polyanalgesic Consensus Conference 2012: Recommendations for the management of pain by intrathecal (spinal) drug delivery: report of an interdisciplinary expert panel. Neuromodulation 2012; 15: 436-66.PubMedCrossRef
69.
Mercadante S, Porzio G, Gebbia V. Spinal analgesia for advanced cancer patients: an update. Crit Rev Oncol Hematol 2012; 82: 227-32.PubMedCrossRef
70.
Ruan X. Drug-related side effects of long-term intrathecal morphine therapy. Pain Physician 2007; 10: 357-66.PubMed
71.
Dominguez JE, Habib AS. Prophylaxis and treatment of the side-effects of neuraxial morphine analgesia following cesarean delivery. Curr Opin Anaesthesiol 2013; 26: 288-95.PubMedCrossRef
72.
Chai T, Bruel BM, Nouri KH, Driver LC. Complications after intrathecal drug delivery due to the underlying malignancy in two patients with intractable cancer pain. Pain Physician 2013; 16: E107-11.PubMed
73.
Neuman SA, Eldrige JS, Qu W, Freeman ED, Hoelzer BC. Post dural puncture headache following intrathecal drug delivery system placement. Pain Physician 2013; 16: 101-7.PubMed
74.
Bezov D, Lipton RB, Ashina S. Post-dural puncture headache: part I diagnosis, epidemiology, etiology, and pathophysiology. Headache 2010; 50: 1144-52.PubMedCrossRef
75.
Aprill D, Bandschapp O, Rochlitz C, Urwyler A, Ruppen W. Serious complications associated with external intrathecal catheters used in cancer pain patients: a systematic review and meta-analysis. Anesthesiology 2009; 111: 1346-55.CrossRef
76.
Ramsey CN, Owen RD, Witt WO, Grider JS. Intrathecal granuloma in a patient receiving high dose hydromorphone. Pain Physician 2008; 11: 369-73.PubMed
77.
Deer TR. A prospective analysis of intrathecal granuloma in chronic pain patients: a review of the literature and report of a surveillance study. Pain Physician 2004; 7: 225-8.PubMed
78.
Deer TR, Prager J, Levy R, et al. Polyanalgesic Consensus Conference–2012: consensus on diagnosis, detection, and treatment of catheter-tip granulomas (inflammatory masses). Neuromodulation 2012; 15: 483-95; discussion 496.
79.
Crul BJ, Delhaas EM. Technical complications during long-term subarachnoid or epidural administration of morphine in terminally ill cancer patients: a review of 140 cases. Reg Anesth 1991; 16: 209-13.PubMed
80.
Sorokin A, Annabi E, Yang WC, Kaplan R. Subdural intrathecal catheter placement: experience with two cases. Pain Physician 2008; 11: 677-80.PubMed
81.
82.
Staats PS. Neuraxial infusion for pain control: when, why, and what to do after the implant. Oncology (Williston Park) 1999; 13(5 Suppl 2): 58-62.
83.
Mercadante S. Problems of long-term spinal opioid treatment in advanced cancer patients. Pain 1999; 79: 1-13.PubMedCrossRef
84.
Infusion Nurses Society. Infusion Nursing Standards of Practice. J Infus Nurs 2006; 29(1 Suppl): S1-92.
85.
Bruera E, Hui D. Spinal analgesia: where is the evidence? Support Care Cancer 2010; 18: 1237.PubMedCrossRef
Metadaten
Titel
Brief review: Neuraxial analgesia in refractory malignant pain
verfasst von
Catherine E. Smyth, MD, PhD
Virginia Jarvis, RN
Patricia Poulin, PhD
Publikationsdatum
01.02.2014
Verlag
Springer US
Erschienen in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 2/2014
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-013-0075-8

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