Myers, J., Chan, V., Jarvis, V., & Walker-Dilks, C. (2010). Intraspinal techniques for pain management in cancer patients: a systematic review. Supportive Care in Cancer, 18(2), 137–149.
To examine the evidence related to intraspinal analgesia and outline resources required to support patients with cancer-related pain
Databases searched were MEDLINE (1950-2008), EMBASE (1980-2008), CINAHL (1982-2008), and the Cochrane Database. A Google internet search was also performed.
Search keywords were intraspinal, epidural, intrathecal injections, pain, cancer, and study design terms for randomized controlled trials and systematic reviews.
Studies were included in the review if they
Studies and reviews were excluded if they
Three systematic reviews, three consensus conferences, and 12 RCTs met the inclusion criteria for evidence of effectiveness. The Appraisal of Guidelines for Research and Evaluation instrument was used to evaluate guidelines. Indicators to evaluate the quality of the other references were publication status (full versus abstract), statement of statistical power or sample size calculation, intention-to-treat analysis, and statement of sponsorship or funding. The final collection of references were eight practice guidelines (which included four local, internal-use, clinical care algorithms or policy and procedure documents and one practice standard), two systematic reviews, and 12 RCTs. Specific information was provided for two systematic reviews, one consensus statement, and 12 RCTs.
Intraspinal analgesia for cancer pain has been shown to provide adequate pain control and fewer side effects than conventional therapy. Because this is an infrequent intervention, high-quality evidence evaluating effectiveness is limited; however, effectiveness has been demonstrated in carefully selected patient groups with intractable pain. Nonopioid effectiveness suggests that use may be most beneficial in situations of opioid refractory pain.
The intraspinal route should be considered as part of a comprehensive pain management strategy. To ensure patient safety, this approach requires appropriate resources and staff guidance via policy and procedures.