New MASCC recommendations on spinal analgesia for cancer pain have just been published in Supportive Care in Cancer.
Cancer pain that doesn’t respond to conventional therapies remains a major challenge in palliative care. A newly published expert consensus from our Palliative Care Study Group and Cancer Pain Subgroup provides practice-oriented guidance on the use of spinal analgesia for refractory cancer pain.
Key Takeaways Include:
- Spinal therapy, particularly via the intrathecal (IT) route, should be considered in cases of refractory cancer pain.
- Morphine and hydromorphone are the opioids of choice for IT therapy and may be enhanced with local anesthetics.
- Use of ziconotide, though requiring careful titration, avoids tolerance and dependence.
- A conversion ratio of 100:1 between oral and IT morphine is suggested for patients who receive high doses of systemic opioids.
- Choice of implantable systems (IDDS or Port-a-Cath) should align with patient prognosis and individual needs.
- The decision-making process for employing therapies like spinal analgesia should be shared, taking into account the actual indications and needs, previous treatments, prognosis, timing, advantages, disadvantages, and potential complications.
