Despite our best efforts, advances in treatment and new technology, pain and suffering continues to afflict those with cancer. Even in those who are cured of their cancer, many will experience devastating physical, psychological and financial devastation.
Although the use of opioids to treat cancer pain is more accepted today, there still are many physicians, patients and family members that are fearful of using opioids because of concerns for addiction, side effects, and religious implications
Pharmacological therapy continues to be the primary method for controlling cancer pain. In fact, the use of non-opioid and opioid analgesics along with adjuvant medications can adequately control the pain in 85% of cancer patients. The World Health Organization (WHO) developed a three-step approach in treating malignant and chronic benign pain. This approach, along with medications to treat the side effects from opioids (namely nausea, constipation, pruritis and sedation), has been effective in controlling cancer pain.
In cancer pain refractory to pharmacological management (15% of cancer patients have unrelieved pain or drug side effects), invasive methods of pain control, such as intrathecal pump drug delivery (IPDD), have been successful in reducing pain and drug toxicity.
Smith et al (Curr Oncol Rep 6:291-296,2004) evaluated 202 patients with a VAS =7.5 and taking = 200 mg morphine or opiod equivalent in a prospective, randomized study. The patients were divided into IPDD and medical management groups. The IPDD patients had better clinical success with lower pain (52% vs. 39%), lower drug toxicity (50% vs. 17%) and lived longer when compared to the medical group. IPDD also lower pain by 27% and lower drug toxicity by 50% in the most refractory of cancer patients who first failed to experience any improvement in the medical group.
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