{"id":3252,"date":"2021-05-19T22:53:59","date_gmt":"2021-05-19T19:53:59","guid":{"rendered":"https:\/\/www.esrahellas.gr\/?page_id=3252"},"modified":"2021-07-16T11:00:00","modified_gmt":"2021-07-16T08:00:00","slug":"spinal-delivery-systems-for-cancer-patients","status":"publish","type":"page","link":"https:\/\/www.esrahellas.gr\/en\/esra-highlights\/spinal-delivery-systems-for-cancer-patients\/","title":{"rendered":"SPINAL DELIVERY SYSTEMS FOR CANCER PATIENTS"},"content":{"rendered":"  <div id=\"page-header-1615708612\" class=\"page-header-wrapper\">\n  <div class=\"page-title dark featured-title\">\n\n    \n    <div class=\"page-title-inner container align-center flex-row medium-flex-wrap\" >\n              <div class=\"title-wrapper flex-col text-left medium-text-center\">\n          <h1 class=\"entry-title mb-0\">\n            SPINAL DELIVERY SYSTEMS FOR CANCER PATIENTS          <\/h1>\n        <\/div>\n                    <div class=\"title-content flex-col flex-right text-right medium-text-center\">\n        <div class=\"title-share pt-half pb-half\"><div class=\"social-icons share-icons share-row relative icon-style-fill\" ><a href=\"https:\/\/www.facebook.com\/sharer.php?u=https:\/\/www.esrahellas.gr\/en\/esra-highlights\/spinal-delivery-systems-for-cancer-patients\/\" data-label=\"Facebook\" onclick=\"window.open(this.href,this.title,'width=500,height=500,top=300px,left=300px'); return false;\" target=\"_blank\" class=\"icon primary button circle tooltip facebook\" title=\"Share on Facebook\" aria-label=\"Share on Facebook\" rel=\"noopener nofollow\"><i class=\"icon-facebook\" aria-hidden=\"true\"><\/i><\/a><a href=\"https:\/\/twitter.com\/share?url=https:\/\/www.esrahellas.gr\/en\/esra-highlights\/spinal-delivery-systems-for-cancer-patients\/\" onclick=\"window.open(this.href,this.title,'width=500,height=500,top=300px,left=300px'); return false;\" target=\"_blank\" class=\"icon primary button circle tooltip twitter\" title=\"Share on Twitter\" aria-label=\"Share on Twitter\" rel=\"noopener nofollow\"><i class=\"icon-twitter\" aria-hidden=\"true\"><\/i><\/a><a href=\"mailto:?subject=SPINAL%20DELIVERY%20SYSTEMS%20FOR%20CANCER%20PATIENTS&body=Check%20this%20out%3A%20https%3A%2F%2Fwww.esrahellas.gr%2Fen%2Fesra-highlights%2Fspinal-delivery-systems-for-cancer-patients%2F\" class=\"icon primary button circle tooltip email\" title=\"Email to a Friend\" aria-label=\"Email to a Friend\" rel=\"nofollow\"><i class=\"icon-envelop\" aria-hidden=\"true\"><\/i><\/a><a href=\"https:\/\/www.linkedin.com\/shareArticle?mini=true&url=https:\/\/www.esrahellas.gr\/en\/esra-highlights\/spinal-delivery-systems-for-cancer-patients\/&title=SPINAL%20DELIVERY%20SYSTEMS%20FOR%20CANCER%20PATIENTS\" onclick=\"window.open(this.href,this.title,'width=500,height=500,top=300px,left=300px'); return false;\" target=\"_blank\" class=\"icon primary button circle tooltip linkedin\" title=\"Share on LinkedIn\" aria-label=\"Share on LinkedIn\" rel=\"noopener nofollow\"><i class=\"icon-linkedin\" aria-hidden=\"true\"><\/i><\/a><\/div><\/div>      <\/div>\n    <\/div>\n\n     \n<style>\n#page-header-1615708612 {\n  margin-bottom: 20px;\n}\n<\/style>\n  <\/div>\n    <\/div>\n  \n<div class=\"row align-middle\"  id=\"row-1275565249\">\n\n\t<div id=\"col-1587201953\" class=\"col medium-3 small-12 large-3\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n\t<div class=\"img has-hover x md-x lg-x y md-y lg-y\" id=\"image_1925520353\">\n\t\t\t\t\t\t\t\t<div class=\"img-inner dark\" >\n\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"729\" height=\"1030\" src=\"https:\/\/www.esrahellas.gr\/wp-content\/uploads\/2021\/05\/berlin-logo.jpg\" class=\"attachment-large size-large\" alt=\"\" \/>\t\t\t\t\t\t\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\n<style>\n#image_1925520353 {\n  width: 100%;\n}\n<\/style>\n\t<\/div>\n\t\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n\t<div id=\"col-745733577\" class=\"col medium-9 small-12 large-9\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<h3>ESRA Highlights<\/h3>\n<p><strong>24th Annual ESRA Congress<\/strong><\/p>\n<p><strong>September 14 &#8211; 17, 2005, Berlin, Germany<\/strong><\/p>\n<p><strong>Congress Highlights<\/strong><\/p>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n<\/div>\n<div class=\"row\"  id=\"row-114105748\">\n\n\t<div id=\"col-1472685768\" class=\"col small-12 large-12\"  >\n\t\t\t\t<div class=\"col-inner text-left\"  >\n\t\t\t\n\t\t\t\n<p><b>SPINAL DELIVERY SYSTEMS IN CANCER PATIENTS<\/b><\/p>\n<p><b>Athina Vadalouca<\/b><\/p>\n<p>Pain Relief and Palliative Care Centre<\/p>\n<p>University of Athens, Greece<\/p>\n<p>For Full Text in pdf form click <a href=\"https:\/\/www.esrahellas.gr\/wp-content\/uploads\/2021\/05\/SPINAL-DELIVERY-SYSTEMS-IN-CANCER-PATIENTS.pdf\" target=\"_blank\">here<\/a>.<\/p>\n<\/p>\n<p>\u2026 \u201cPain is a Disease in Its Own Right\u201d EFIC Declaration, 2001<\/p>\n<p>The ongoing worldwide debate regarding assisted suicide has raised physician and public awareness about the problem of intractable pain in cancer patients [1]. The main reasons for the failure to achieve control of pain are inexperience and lack of knowledge of the simple principles of effective analgesic use and in many countries the non \u2013 availability of strong opioid analgesics [2]. Most of us accept that orally administered opioids are the best route because of the simplicity and cost effectiveness. Patients with cancer pain receiving orally opioids and adjuvant drugs may experience adequate pain control \u03afn 80-90% of cases. \u0399n the rest 10-20% of the cases some form of invasive therapies will be needed.<\/p>\n<p>Ever since the application in 1980 of morphine for spinal analgesia \u03afn patients with refractory cancer pain, spinal infusion therapy has become one of the cornerstones for the management of chronic intractable pain.<\/p>\n<p>In the last two decades the introduction and development of drug delivery systems has created new ways to treat intractable cancer pain. The brief review of pain medication delivery, definitely showing that the method is helpful in cancer pain, although the rare complication of mass formation of the catheter tip [3].<\/p>\n<p>Before we decide to implant a system in order to have a better outcome exclusion evidence must be considered.<\/p>\n<p><b>Exclusion Criteria<\/b><\/p>\n<p><b>\u0391<\/b><b>bsolute<\/b><\/p>\n<p style=\"padding-left: 40px;\">Aplastic anaemia<\/p>\n<p style=\"padding-left: 40px;\">Systemic infection<\/p>\n<p style=\"padding-left: 40px;\">Known allergies to the material<\/p>\n<p style=\"padding-left: 40px;\">Known allergies to the intended medication<\/p>\n<p style=\"padding-left: 40px;\">Active intravenous drug abuse<\/p>\n<p style=\"padding-left: 40px;\">Psychosis \/ Dementia<\/p>\n<p><b>Relative<\/b><\/p>\n<p style=\"padding-left: 40px;\">Receiving ongoing anticoagulation therapy<\/p>\n<p style=\"padding-left: 40px;\">Child before fusion of the epiphysis<\/p>\n<p style=\"padding-left: 40px;\">Recovering drug addict<\/p>\n<p style=\"padding-left: 40px;\">Opioid n\u03bfn responsivity<\/p>\n<p style=\"padding-left: 40px;\">Lack of social \/family support<\/p>\n<p style=\"padding-left: 40px;\">Socio-economic problems<\/p>\n<p>Many factors determine the clinical efficacy of the spinal opioid delivery systems. These include:<\/p>\n<ul>\n<li>Patient Selection<\/li>\n<li>Characteristics of the delivery system used<\/li>\n<li>Route Selection<\/li>\n<li>Drug Selection<\/li>\n<li>Cost of the system used<\/li>\n<li>Complications<\/li>\n<\/ul>\n<p>In terms of patient selection we need to consider [2]:<\/p>\n<ul>\n<li>Life Expectancy<\/li>\n<li>\u03a1ain Origin and Mechanism<\/li>\n<li>Spinal Canal Assessment<\/li>\n<li>Unmanageable Side-effects with Oral Opioids<\/li>\n<li>Patient&#8217;s Environment<\/li>\n<\/ul>\n<p>\u0399n terms of the characteristics of the delivery system used we need to classify:<\/p>\n<ul type=\"disc\">\n<li>Percutaneous Catheters<\/li>\n<li>Subcutaneous surgically-implanted catheter for drug administration via an external PCA pump<\/li>\n<li>Surgically-implanted catheters with subcutaneous port<\/li>\n<li>Surgically-implanted catheter with implanted infusion pump at a fixed rate<\/li>\n<li>Surgically-implanted catheter with implanted programmable infusion pump<\/li>\n<\/ul>\n<p>Last year a new device was introduced by Medronic: The PCA in intrathecal therapy for chronic pain.<\/p>\n<p>There are many advantages and disadvantages of the intraspinal devices depending on the type of the device. Before the implantation of the delivery system it is important to perform an appropriate trial in order to know if the administration of opioids has side effects or if the patient demonstrates pain relief [5].<\/p>\n<p>Regarding route selection the decision should be inpidualized to patient&#8217;s circumstances. Comparative studies have shown that the intrathecal administration of morphine may give more satisfactory pain relief with lower doses of morphine and fewer side effects than epidural administration. However, the epidural administration reduces the risk of neurotoxity. Hassenbusch et al suggested the intrathecal infusion with a daily opioid dose as low as possible in order to reduce the incidents \u03bff catheter-tip inflammatory masses [6]. \u0399n terms of drug selection, consensus guidelines were developed by an expert paneI [7]. The panel&#8217;s review suggested that the mainstay drug for long term intrathecal infusion has been morphine that should be considered the first line strategy for most patients. From a comparison of intrathecal Drug Therapy (IDT) with Conventional \u03a1ain Therapy (CPT) in patients suffering from chronic pain it was shown that lDT is cost- effective in the long-term despite high initial costs of implantable devices [8].<\/p>\n<p>Finally, before considering the use of invasive devices we must be fully aware of all the potential complications of the procedure, the device and the drugs used. As a conclusion we can say that the intraspinal techniques available to treat intractable pain have significantly enhanced our ability to relief suffering.<\/p>\n<p>But as anaesthesiologists involved in homecare of patients with implanted devices such as morphine pumps and epidural injections or PCA should be aware of potential complications that may have severe outcomes because frequency and payments of claims associated with chronic pain management by anaesthesiologists, increased in the 1990\u2019s.<\/p>\n<p><b>References<\/b><\/p>\n<ol type=\"1\">\n<li>Hassenbusch JS et al. Clinical Realities and Economic Considerations: Economics of Intathecal Therapy. J Pain Symptom Management, 1997; 14 (3): 36 \u2013 48.<\/li>\n<li>Vadalouca A. Cancer Pain Relief by PCA Pump Infusion. Management of Pain. A world Perspective II. International Proceedings pision, Monduzzi Editore, 1996, pages 338 \u2013 345.<\/li>\n<li>Penn RD. Intrathecal Pain Medication Delivery. Neurosurg Clin North Am, 2003; 4 (3): 381 \u2013 382.<\/li>\n<li>Maeyaert J et al. PCA, an Intrathecal Therapy for Chronic Pain: Safety and Effective Operation of the Model 8831 Personal Therapy Manager with a Pre \u2013 Implanted Synchro Med Infusion System. Neuromodulation, 2003; 6 (3): 133 \u2013 141.<\/li>\n<li>Panchal JS et al. Intrathecal Pumps. Techniques in Regional Anaesthesia and Pain Management, 2000; 2 (3): 137 \u2013 142.<\/li>\n<li>Hassenbusch JS et al. Management of Intrathecal Catheter \u2013 Tip Inflammatory Masses: A Consensus Statement. Pain Medicine, 2002; 3 (4): 313 \u2013 323.<\/li>\n<li>Bennet G et al. Clinical Guidelines for Intraspinal Infusion. Journal Pain Symptom Management, 2000; 20 (2): 38 \u2013 42.<\/li>\n<li>Kumar K et al. Treatment of Chronic Pain by Using Intrathecal Drug Therapy Compared with Conventional Pain Therapies: Cost \u2013 Effectiveness Analysis. J Neurosurg, 2002; 97: 803 \u2013 810.<\/li>\n<\/ol>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n<\/div>\n\t<div id=\"gap-1586230101\" class=\"gap-element clearfix\" style=\"display:block; height:auto;\">\n\t\t\n<style>\n#gap-1586230101 {\n  padding-top: 30px;\n}\n<\/style>\n\t<\/div>\n\t\n<div class=\"social-icons share-icons share-row relative full-width text-center\" ><a href=\"https:\/\/www.facebook.com\/sharer.php?u=https:\/\/www.esrahellas.gr\/en\/esra-highlights\/spinal-delivery-systems-for-cancer-patients\/\" data-label=\"Facebook\" onclick=\"window.open(this.href,this.title,'width=500,height=500,top=300px,left=300px'); return false;\" target=\"_blank\" class=\"icon primary button circle tooltip facebook\" title=\"Share on Facebook\" aria-label=\"Share on Facebook\" rel=\"noopener nofollow\"><i class=\"icon-facebook\" aria-hidden=\"true\"><\/i><\/a><a href=\"https:\/\/twitter.com\/share?url=https:\/\/www.esrahellas.gr\/en\/esra-highlights\/spinal-delivery-systems-for-cancer-patients\/\" onclick=\"window.open(this.href,this.title,'width=500,height=500,top=300px,left=300px'); return false;\" target=\"_blank\" class=\"icon primary button circle tooltip twitter\" title=\"Share on Twitter\" aria-label=\"Share on Twitter\" rel=\"noopener nofollow\"><i class=\"icon-twitter\" aria-hidden=\"true\"><\/i><\/a><a href=\"mailto:?subject=SPINAL%20DELIVERY%20SYSTEMS%20FOR%20CANCER%20PATIENTS&body=Check%20this%20out%3A%20https%3A%2F%2Fwww.esrahellas.gr%2Fen%2Fesra-highlights%2Fspinal-delivery-systems-for-cancer-patients%2F\" class=\"icon primary button circle tooltip email\" title=\"Email to a Friend\" aria-label=\"Email to a Friend\" rel=\"nofollow\"><i class=\"icon-envelop\" aria-hidden=\"true\"><\/i><\/a><a href=\"https:\/\/www.linkedin.com\/shareArticle?mini=true&url=https:\/\/www.esrahellas.gr\/en\/esra-highlights\/spinal-delivery-systems-for-cancer-patients\/&title=SPINAL%20DELIVERY%20SYSTEMS%20FOR%20CANCER%20PATIENTS\" onclick=\"window.open(this.href,this.title,'width=500,height=500,top=300px,left=300px'); return false;\" target=\"_blank\" class=\"icon primary button circle tooltip linkedin\" title=\"Share on LinkedIn\" aria-label=\"Share on LinkedIn\" rel=\"noopener nofollow\"><i class=\"icon-linkedin\" aria-hidden=\"true\"><\/i><\/a><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":3182,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-blank.php","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-3252","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - 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