Presented at the 2013 AAPM Annual Meeting « Back

Patient-Controlled Intrathecal Analgesia for the Management of Severe Cancer Pain: A Prospective Survey of Breakthrough Pain Management

Natalie B. Winter, MD, natalie.winter@hsc.utah.edu¹, Shane E. Brogan, MB BCh², (1) University of Utah School of Medicine, Salt Lake City, Utah, (2) University of Utah, Salt Lake City, Utah

Introduction: Implantable and programmable intrathecal drug delivery systems (IDDS) have become an accepted and safe modality for treating chronic pain, particularly in cancer pain. Recently, a hand-held device to bolus additional medication for breakthrough pain has been introduced. We hypothesize that patient controlled intrathecal analgesia (PCIA) for the treatment of breakthrough pain results in improved pain control and cancer symptom reporting. Methods: 37 patients had an IDDS placed for the treatment of cancer pain and were prospectively followed. Patients performed a breakthrough pain survey and a MD Anderson Symptom Inventory (MDASI) at baseline and at 4-6 weeks. IRB approval was obtained on the survey and research protocol. Results: Thirteen patients were in the final population after excluding patients for early death, hospice admission, or lost follow-up. Prior to intrathecal therapy (ITT), patients estimated a mean of 30 minutes for conventional breakthrough medications to be effective, as compared to 9 minutes with PCIA. A 45% reduction in pain was reported with breakthrough medications prior to ITT; this increased to 71% with PCIA. All patients thought PCIA provided superior pain control compared to before ITT. The numerical rating scale pain score decreased from 6.2 to 2.2 after ITT (p<.001). The MDASI composite score improved from 99 to 77 after ITT (p=.02). Conclusions: Compared to conventional treatments, breakthrough cancer pain control with intrathecal therapy with PCIA is associated with faster and more effective pain control, higher patient satisfaction, and a global improvement of cancer related symptoms. References: 1) Brogan SE, Winter NB. Patient-controlled intrathecal analgesia for the management of breakthrough cancer pain: a retrospective review and commentary. Pain Medicine. 2011;12(12):1758-68. 2) 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(19):4 3) Stearns L, Boortz-Marx R, Du Pen S, et al. Intrathecal drug delivery for the management of cancer pain: A multidisciplinary consensus of best clinical practices. J Support Oncol 2005;3(6):399–408. 4) Cleeland CS, Gonin R, Hatfield AK, et al. Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 1994;330(9):592–6. 5) Rauck RL, Cherry D, Boyer MF, Kosek P, Dunn J, Alo K. Long-term intrathecal opioid therapy with a patient-activated, implanted delivery system for the treatment of refractory cancer pain. J Pain 2003;4(8):441–7.

Funding: None