Page 63 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)
and pelvic cancer pain (MD= -0.67, 95% CI -1.29 to -0.05). However,
AEs were not discussed. 93, level I

In a pre- and post-study on patients with uncontrolled pelvic oncologic
SDLQ ZLWK WKH HVWDEOLVKHG WKHUDS\ RU H[SHULPHQWLQJ RSLRLG $(V JDQJOLRQ
LPSDU QHXURO\VLV VKRZHG D VLJQL¿FDQW UHGXFWLRQ LQ SDLQ VFRUH DQG
morphine consumption up to three months follow-up. AEs were not
discussed. 94, level II-3

(YLGHQFH RQ VRPDWLF SOH[XV QHXURO\VLV H J EUDFKLDO RU OXPERVDFUDO
SOH[XV ZDV FRQ¿QHG WR FDVH UHSRUWV

1HXUD[LDO 2SLRLGV

1HXUD[LDO RSLRLGV LQYROYH WKH GHOLYHU\ RI GUXJV YLD HSLGXUDO LQWUDWKHFDO
or intracerebroventricular routes. A catheter drug delivery system with
the aid of either a subcutaneous implanted device or spinal port with
DQ H[WHUQDO V\ULQJH SXPS SURYLGHV DQ HIIHFWLYH WKHUDSHXWLF RSWLRQ IRU
refractory cancer pain.
In a cohort of refractory pancreatic cancer pain, 64.3% of patients
ZLWK LQWUDWKHFDO GUXJ GHOLYHU\ V\VWHPV H[SHULHQFHG ! SDLQ
reduction from baseline after three months of treatment initiation
(p<0.01). 95, level II-2

A systematic review for the European Palliative Care Research
Collaborative (EPCRC) guidelines found no difference in pain scores
EHWZHHQ QHXUD[LDO EROXV DQG FRQWLQXRXV RSLRLG LQIXVLRQ 7KHUH ZDV
also no difference between epidural morphine and systemic morphine.
It was concluded that spinal opioid therapy may be effective for treating
cancer pain not adequately controlled by systemic treatment based on
weak evidence. 96, level I

$ PRUH UHFHQW PHWD DQDO\VLV VKRZHG D VLJQL¿FDQW PHDQ SDLQ VFRUH
reduction of 3.64 (95% 3.09 to 4.18), up to one-month post-implantation
based on retrospective studies. Improvements in symptom severity
ZHUH DVVRFLDWHG ZLWK LPSURYHG 4R/ ,Q DGGLWLRQ DOO LQFOXGHG VWXGLHV
that assessed the use of systemic opioids at baseline showed a dose
reduction following implantation. The most common intrathecal opioid
was morphine, which was used alone or in combination with adjuvants
such as bupivacaine, ropivacaine, clonidine or baclofen. 137, level I

$ SURVSHFWLYH SURGXFW VXUYHLOODQFH UHJLVWU\ UHSRUWHG VHYHUH $(V 6$(V
from intrathecal implantable device comprised of infection (3.2%), post-
GXUDO SXQFWXUH KHDGDFKHV FHUHEURVSLQDO ÀXLG OHDNV SXPS
pocket haematoma (0.28%) and pneumonia (0.14%). Other AEs of
V\VWHPLF RSLRLGV PD\ RFFXU LQ QHXUD[LDO RSLRLG WKHUDS\ H J QDXVHD
45

e-cpg inside text-Cancer pain-25/5/24.indd 45 09/08/2024 12:09 AM