Intrathecal therapy for cancer and nonmalignant pain: Patient selection and patient management

Timothy Deer, Wolfhard Winkelmuller, Serdar Erdine, Marshall Bedder, Kim Burchiel

Research output: Contribution to journalArticlepeer-review

47 Scopus citations

Abstract

Intrathecal drug delivery improves pain relief, reduces suffering, and enhances quality of life in the small proportion of patients who do not respond well to oral analgesics, including oral morphine. Although morphine is the 'gold standard,' and the only drug approved for intrathecal pain therapy in the United States, off-label use of alternative agents appears promising, particularly in patients with neuropathic pain. Careful patient selection and management are significant determinants of successful treatment outcomes. Patient selection criteria for cancer and nonmalignant pain are similar; however, a more comprehensive psychological and social assessment is required for patients with nonmalignant pain. In addition, all patients (those with cancer or nonmalignant pain) must exhibit a positive response to an epidural or intrathecal screening test. A multidisciplinary team approach, involving psychologists, nurses, physical therapists, social workers, and spiritual leaders should be used to manage patients. Current practices for patient selection and management, screening tests, and dosing guidelines for intrathecal drug delivery systems are discussed.

Original languageEnglish (US)
Pages (from-to)55-66
Number of pages12
JournalNeuromodulation
Volume2
Issue number2
DOIs
StatePublished - Jan 1 1999

Keywords

  • Cancer
  • Cancer pain
  • Intrathecal therapy
  • Nonmalignant pain
  • Opioids

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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