Intrathecal Therapy For the Management of Cancer and Noncancer Pain

ancer pain results from the growth of cancer in human tissues, as well as the therapies implemented to treat a malignancy. Adequate pain control can be achieved in the great majority of patients by implementing an aggressive pharmacologic treatment strategy using opioids and adjuvants. The implementation of such a strategy may achieve adequate pain control in 90% to 95% of patients. Consequently, 5% to 10% of patients will require some form of invasive therapy. When specific guidelines are followed, the great majority of patients with cancer-related pain can expect adequate pain control. Control of pain and its related symptoms is a cornerstone of cancer treatment because it enhances quality of life by improving function and promoting compliance with treatment. Control of pain allows patients to focus on the joys of life. In addition to its salutary effects on quality of life, mounting evidence suggests that good pain control may positively influence survival. To implement optimal analgesic therapy, a thorough history and physical examination are essential, as is the judicious use of diagnostic testing to try to define the pathophysiologic components involved in the expression of pain. Intrathecal (IT) opioids are very effective for the treatment of somatic and visceral pain, but IT bupivacaine and/or clonidine is necessary for the treatment of neuropathic pain. Thus, a definition of the specific pathophysiologic components of a patient’s pain is critical for successful management of it. Part I: Cancer Pain