Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France.
Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool - UK.
Pain Physician. 2022 May;25(3):E414-E425.
Cancer pain prevalence remains high with more than 60% of patients with advanced cancer experiencing cancer-related pain. The undertreatment of pain due to concerns of opioid dependence or diversion, as well as the potential effect of opioids on tumor neogenesis, add to the suffering among cancer populations.
The aim of this narrative review was to assess evidence on the effectiveness, safety, cost-effectiveness, and advances of Intrathecal (IT) Drug Delivery Systems (IDDS) for the management of cancer pain.
The present review was performed by searching for articles indexed in PubMed, MEDLINE, SciELO, Google Scholar, and Scopus.
Studies were included if they investigated patients with chronic cancer-related pain treated with IDDS and assessed experienced pain. We performed a narrative synthesis.
IDDS have demonstrated efficacy in relieving cancer pain even in the challenging treatment of head and neck cancer pain. IDDS is also associated with a large reduction in serum opioid concentrations limiting adverse effects. When combined with other analgesics commonly used in the spinal space, but not systemically, pain relief may be dramatically improved. Advances in IT drug diffusion, including mixtures created with pharmaceutical compounding, improve the safety and accuracy of this therapy. IDDS is cost-effective and safe yet remains underutilized in this patient population.
Despite numerous clinical studies, only a small number of randomized trials have been conducted to evaluate the effectiveness of IDDS for cancer pain.
This article presents an overview of the current state of evidence on the effectiveness, safety, cost-effectiveness, and advances of IDDS for the management of cancer pain. Despite current evidence, IDDS remains underutilized for people with cancer pain. Potential areas to facilitate its use are discussed. A shift in the paradigm of cancer pain treatment should be considered given the undertreatment rate, lack of benefits, and considerable risks associated with oral opioid medication in many patients who suffer from chronic cancer pain.
超过 60%的晚期癌症患者都经历过癌痛，癌症疼痛的发病率仍然很高。由于担心阿片类药物依赖或滥用，以及阿片类药物可能对肿瘤新生的影响，加上癌症患者的痛苦，导致疼痛治疗不足。
本叙述性综述旨在评估鞘内（IT）药物输送系统（IDDS）治疗癌症疼痛的有效性、安全性、成本效益和进展。
本综述通过在 PubMed、MEDLINE、SciELO、Google Scholar 和 Scopus 中检索索引文章进行。
如果研究对象为接受 IDDS 治疗的慢性癌症相关疼痛患者，并评估其疼痛体验，则纳入研究。我们进行了叙述性综合分析。
IDDS 已被证明在缓解癌症疼痛方面非常有效，即使在治疗头颈部癌症疼痛等具有挑战性的情况下也是如此。IDDS 还与血清阿片类药物浓度的大幅降低相关，从而限制了不良反应。当与其他通常在脊髓空间使用但不全身使用的镇痛剂联合使用时，疼痛缓解可能会显著改善。IT 药物扩散方面的进步，包括使用药物配制的混合物，提高了这种治疗的安全性和准确性。IDDS 具有成本效益且安全，但在该患者人群中的应用仍然不足。
尽管有许多临床研究，但只有少数随机试验被用于评估 IDDS 治疗癌症疼痛的有效性。
本文概述了当前关于 IDDS 治疗癌症疼痛的有效性、安全性、成本效益和进展的证据状况。尽管有当前的证据，但 IDDS 在治疗癌症疼痛方面的应用仍然不足。讨论了促进其使用的潜在领域。鉴于许多患有慢性癌症疼痛的患者口服阿片类药物治疗的未治疗率、缺乏益处和相当大的风险，应该考虑改变癌症疼痛治疗的范式。
