Implantable intrathecal pumps for refractory cancer pain

Cancer pain is often inadequately managed with standard systemic therapies. Targeted intrathecal administration of analgesics via implantable (internal) intrathecal pumps may improve analgesia and reduce systemic adverse effects. However, treatment with external pumps may place a substantial burden on patients and their caregivers due to the frequent need for medication reservoir refills. In addition, external pumps can be cumbersome and may interfere with patients’ daily activities. Recently, implantable intrathecal pumps placed in the subcutaneous tissue have become increasingly used. These devices allow the administration of highly concentrated drug solutions and less frequent refilling, which may significantly improve quality of life. We conducted a prospective pilot study including eight patients with advanced cancer and refractory pain. Two patients received analgesic therapy via an implantable intrathecal pump, while six were treated using a subcutaneous pump. Pain intensity and quality of life were assessed using the Visual Analogue Scale (VAS), the Edmonton Symptom Assessment System (ESAS), and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Assessments were performed during the first four weeks after pump implantation. Intrathecal pump therapy was associated with a faster and more sustained reduction in pain compared with subcutaneous pumps. Patients treated with intrathecal pumps demonstrated better overall health status, more favourable functional and symptom profiles, and a lower incidence of treatment-related adverse effects. Implantable intrathecal pumps may enable more effective pain control and significantly improve quality of life in carefully selected patients with refractory cancer pain compared with subcutaneous administration. Larger, well-designed prospective studies are needed to confirm these findings.