From the October 1, 2002 issue of the Journal of Clinical Oncology

Many cancer patients will experience at least some pain during the course of their illness, requiring careful management from their oncology team. A small percentage of these patients will have severe, refractory pain, pain that is difficult to treat and does not respond well to even the strongest medications. 

In recent years, however, scientists have developed a new way of treating refractory pain, allowing many patients with advanced cancer to function normally and continue spending time with their families and friends. This method involves the use of a small pump - called an implantable intrathecal drug delivery system (IDDS) - that slowly delivers pain medication to the spinal cord. The pump is implanted under the skin, with little discomfort to the patient.

A new study has compared the use of this pump to "comprehensive medical management," a mix of medicines and medical procedures based on a set of national guidelines, providing the best that conventional medicine has to offer for cancer patients with severe pain. The researchers found that, while both methods helped to relieve severe pain, the level of pain relief was greater with the pump than with comprehensive medical management. They also found that both forms of pain management reduced side effects from pain medication, although side effects were even fewer with the pump.  According to the study's lead author, Dr. Thomas J. Smith, good pain management should both relieve pain and limit the side effects of pain medications. Unfortunately, studies suggest that many cancer patients to not receive the full range of pain management available to them. 

What Does This Mean for Patients? 

This study shows that even advanced cancer patients with severe, hard-to-treat pain can receive care that allows them to function more normally. Dr. Smith stressed that patients should demand good pain relief from their cancer team. "There is no reason that cancer patients should be forced to live with unrelieved pain," he said.Dr. Smith also pointed out that the implantable pump is not for everyone, and that comprehensive medical management can provide good pain relief, with few side effects, for most cancer patients.

With the care of an experienced pain specialist, the small percentage of patients who would benefit from the implantable pump can be identified early in their treatment and be offered the pain relief they need. Patients with severe pain who would like to learn more about the pump should speak with their doctor.