The Need of a Comprehensive Approach in a Condition of Poorly Opioid-Responsive Cancer Pain

Background. Spinal analgesia is often claimed as an effective strategy for patients with a poor response to systemic opioids. Despite the optimistic data reported in literature with intrathecal drug delivery systems (IDDS) for cancer pain, a critical analysis showed modest benefit. Indeed, intrathecal therapy may be potent means to be used in a very selected population. However, ability to manage spinal therapy combined with the use of opioids and other drugs in the general perspective of a comprehensive palliative care treatment may allow to resolve refractory cancer pain in a patient with a clinical profile of poor pain prognosis, according to the Edmonton staging system. Methods. A long-term management of patients who underwent different therapeutic approaches, including multiple opioid lines, intrathecal analgesia, and a comprehensive palliative care treatment, is described. Results. The case reported describes how the management of cancer pain may be complex, requiring a high level of expertise on using opioids, conversion ratios, different routes, particularly the intrathecal one, as well as providing a comprehensive palliative care treatment. Conclusions. No evidence-based treatment can be taken into consideration for such extreme conditions, where only experience and knowledge can guide to an effective course of treatment along a period of about six months. Timely therapeutic strategies are needed to be performed in each challenging clinical situation along the course of disease. J Pain Symptom Manage 2023;66:e611-e614. (c) 2023 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Automated summary

Spinal analgesia may be effective for specific populations, but its application in comprehensive palliative care requires high expertise in managing opioids, different routes, particularly intrathecal, and providing comprehensive palliative care.