Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, New Orleans, LA, USA.
Curr Pain Headache Rep. 2018 Feb 5;22(2):11. doi: 10.1007/s11916-018-0662-z.
The purpose of the present investigation is to summarize the body and quality of evidence including the most recent studies in support of intrathecal drug delivery systems and spinal cord stimulation for the treatment of cancer-related pain.
In the past 3 years, a number of prospective studies have been published supporting intrathecal drug delivery systems for cancer pain. Additional investigation with adjuvants to morphine-based analgesia including dexmedetomidine and ziconotide support drug-induced benefits of patient-controlled intrathecal analgesia. A study has also been recently published regarding cost-savings for intrathecal drug delivery system compared to pharmacologic management, but an analysis in the Ontario, Canada healthcare system projects additional financial costs. Finally, the Polyanalgesic Consensus Committee has updated its recommendations regarding clinical guidelines for intrathecal drug delivery systems to include new information on dosing, trialing, safety, and systemic opioid reduction. There is still a paucity of clinical evidence for spinal cord stimulation in the treatment of cancer pain. There are new intrathecal drugs under investigation including various conopeptides and AYX1. Large, prospective, modern, randomized controlled studies are still needed to support the use of both intrathecal drug delivery systems as well as spinal cord stimulation for cancer pain populations. There are multiple prospective and small randomized controlled studies that highlight a potential promising future for these interventional modalities. Related to the challenge and urgency of cancer pain, the pain practitioner community is moving toward a multimodal approach that includes discussions regarding the role of intrathecal therapies and spinal cord stimulation to the individualized treatment of patients.
本研究旨在总结包括最新研究在内的鞘内药物输送系统和脊髓刺激治疗癌痛的证据体和质量。
在过去 3 年中，发表了许多支持鞘内药物输送系统治疗癌痛的前瞻性研究。对吗啡类镇痛辅助药物（包括右美托咪定和齐考诺肽）的进一步研究支持了患者自控鞘内镇痛的药物诱导获益。最近还发表了一项关于与药物治疗相比鞘内药物输送系统节省成本的研究，但安大略省加拿大医疗保健系统的分析预测会增加额外的财务成本。最后，多模式镇痛共识委员会更新了其关于鞘内药物输送系统临床指南的建议，包括关于剂量、试验、安全性和系统阿片类药物减少的新信息。脊髓刺激治疗癌痛的临床证据仍然很少。正在研究新的鞘内药物，包括各种 conopeptides 和 AYX1。仍需要大型、前瞻性、现代、随机对照研究来支持鞘内药物输送系统和脊髓刺激治疗癌痛人群的应用。有许多前瞻性和小型随机对照研究强调了这些介入性治疗方法的潜在前景。鉴于癌痛的挑战性和紧迫性，疼痛从业者社区正在转向一种多模式方法，包括讨论鞘内治疗和脊髓刺激在个体化治疗患者中的作用。
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