Bruel Brian M, Burton Allen W
*University of Texas, MD Anderson Cancer Center, Houston, Texas
St. Jude Medical, Minneapolis, Minnesota, USA.
Pain Med. 2016 Dec;17(12):2404-2421. doi: 10.1093/pm/pnw060. Epub 2016 Apr 28.
The increasing incidence of cancer survivorship has shifted treatment of cancer-related pain from short-term analgesia to long-term chronic pain management. As a result, alternatives to oral analgesics, such as intrathecal therapy, may be beneficial for patients with cancer-related pain. The authors review the use of intrathecal therapy in the management of cancer-related pain.
The Medline database was searched for English-language articles that included "ziconotide" or "morphine" AND ("cancer" OR "malignant") AND "intrathecal" in title or abstract. Available abstracts from scientific congresses in the areas of neuromodulation and oncology were also reviewed.
Intrathecal therapy provides pain relief with reduced systemic concerns in patients with cancer-related pain. Patients should undergo multidisciplinary evaluation and, in most cases, drug trialing before intrathecal pump implantation. Morphine, an opioid ( Μ: -opioid receptor antagonist), and ziconotide, a nonopioid (selective N-type calcium channel inhibitor), are both approved for intrathecal analgesia; however, tolerance and safety concerns may deter the use of intrathecal morphine. Ziconotide has also shown efficacy for reduction of cancer-related pain; however, proper dosing and titration must be used to prevent adverse events. There is little information available on use of intrathecal therapies specifically in cancer survivors.
Treatment of cancer-related pain has shifted toward chronic pain management strategies, especially among cancer survivors. Intrathecal therapy provides an alternate route of administration of chronic pain medications (e.g., morphine and ziconotide) for cancer patients with and without active disease, although additional research is needed to support effectiveness in cancer survivors.
癌症幸存者的发病率不断上升，使得癌症相关疼痛的治疗从短期镇痛转向长期慢性疼痛管理。因此，鞘内治疗等口服镇痛药的替代方法可能对癌症相关疼痛患者有益。作者综述了鞘内治疗在癌症相关疼痛管理中的应用。
在Medline数据库中检索标题或摘要中包含“齐考诺肽”或“吗啡”以及（“癌症”或“恶性肿瘤”）和“鞘内”的英文文章。还查阅了神经调节和肿瘤学领域科学大会的可用摘要。
鞘内治疗可为癌症相关疼痛患者缓解疼痛，同时减少全身不良反应。患者在植入鞘内泵之前应接受多学科评估，并且在大多数情况下要进行药物试验。吗啡（一种阿片类药物，μ阿片受体拮抗剂）和齐考诺肽（一种非阿片类药物，选择性N型钙通道抑制剂）均已获批用于鞘内镇痛；然而，耐受性和安全性问题可能会阻碍鞘内吗啡的使用。齐考诺肽也已显示出减轻癌症相关疼痛的疗效；然而，必须采用适当的剂量和滴定方法以预防不良事件。关于鞘内治疗在癌症幸存者中的具体应用，可用信息很少。
癌症相关疼痛的治疗已转向慢性疼痛管理策略，尤其是在癌症幸存者中。鞘内治疗为患有或未患有活动性疾病的癌症患者提供了一种慢性疼痛药物（如吗啡和齐考诺肽）的替代给药途径，尽管还需要更多研究来支持其在癌症幸存者中的有效性。
