- Design
- Systematic review with meta-analysis of pain intensity
- Population
- 15 studies of adults with refractory cancer pain treated via partially implanted intrathecal devices
- Primary outcome
- Pain intensity at 4 weeks; opioid dose, quality of life, complications
- Effect
- Significant pain reduction at 4 weeks (moderate certainty); lower opioid use and complications
This systematic review included 15 studies of adults with refractory cancer pain treated with intrathecal therapy through partially implanted devices — an external pump connected to an intrathecal catheter — compared with conventional management or fully implanted pumps.
A meta-analysis showed significantly lower pain at four weeks with intrathecal therapy. Systemic opioid doses fell and quality of life improved. Complication rates were lower than with conventional therapy. Certainty was moderate for pain and quality of life and low for other outcomes.
Intrathecal delivery is underused in cancer pain, partly because fully implanted pumps are costly and slow to arrange. Partially implanted systems can be placed faster and suit patients with a limited prognosis, which is where they are most often needed.
- Consider intrathecal therapy for cancer pain uncontrolled despite optimised systemic analgesia.
- Partially implanted systems may suit patients with limited life expectancy.
- Refer early to pain or palliative services that offer intrathecal delivery.
- Expect lower systemic opioid needs and fewer opioid side effects.
Why it matters
Patients with the worst cancer pain are often not offered intrathecal options at all.
Don't overread it
Evidence was low to moderate certainty, and the abstract does not give the size of the pain reduction.
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