Spinal Narcotic Pumps for Cancer-related pain

ADVANCED TECHNIQUES FOR CANCER PAIN

Nearly 75% of all patients with advanced cancer report pain as a significant complaint. Of these, 70-90% will be adequately treated with oral medications or systemic opiods.

FOR THOSE WHO NEED SOMETHING MORE

Between 10-30% of patients with cancer pain will require something more sophisticated to provide relief of their intractable pain. After oral medications, nerve blocks and strong narcotics fail to provide adequate relief, an approach called "IMPLANTABLE INTRASPINAL DRUG INFUSION" may be an appropriate therapeutic choice.

THE IMPLANTABLE TECHNIQUE

Implantable Intraspinal Drug Infusion, or IIDF, is a technique that uses a thin, permanent catheter to deliver potent narcotics directly to the spinal cord. ;By delivering the narcotics to the spinal cord, where "narcotic receptors" are located, pain relief can be achieved where it may not have been achievable any other way.

Patients with cancer often experience nausea and vomiting. Unfortunately, the disease process, as well as the chemotherapy that is used to treat cancer commonly cause these problems. If gastro-intestinal function is significantly disrupted, oral medications simply cannot enter the blood stream and have a meaningful chance to work.

If the narcotics and other pain relievers are delivered through an I.V., activities of daily life are limited by the presence of an I.V. catheter, line, and pole. Additionally, the narcotic is administered to the blood stream, where it is allowed to go to be delivered to the entire body. The majority of the administered narcotic ends up in locations where it is not needed, and side-effects can be expected.

If a catheter were to be safely placed in the spinal canal, and attached to a pump that is placed under the skin, the narcotic could be infused constantly, without the bother of external paraphanalia, and the additional benefit of direct application of the medication on the spinal cord, where the most profound pain relief is achieved. Side effects are thereby minimized, and pain relief is maximized.

PATIENT SELECTION

The implantable pump technique is most appropriate for patients with a life-expectancy of 3 to 6 months or longer. The implantable-programmable drug infusion system became commercially available in late 1991. The implantable pump permits drug delivery in such a fashion that remarkable reductions in required narcotic dosages are routinely observed. Through this technique, required narcotic dosages may be reduced to as little as 1% of the observed oral dosages of narcotic and 10% of of the epidural and I.V. dosages.

By reducing the amount of administered narcotic, and by specifically delivering the narcotic to the most sensitive areas, side-effects may be dramatically reduced.

ECONOMICS

This is not an inexpensive technique, and is clearly not for every patient situation. The advantages of the IIDF pump system include less frequent refills, non-invasive changes in dosage, and programmable dosing schedule to accommodate variations in pain relief required throughout the day.

The higher initial costs of this medical device and implantation procedure may are offset over time by the lower maintenance and drug costs. The IIDF system may actually cost less than an external drug delivery system, such as an I.V. as early as four months post implantation. Fewer nursing visits are necessary, and the quality of life improves dramatically.

Drug refills are required every month or two, and it is wise to visit the physician every month or so.