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Evidence summaries

Epidural, Subarachnoid, and Intracerebroventricular Opioids for Cancer Pain

Epidural, subarachnoid, and intracerebroventricular (ICV) administration of opioids all appear to be effective in relieving intractable cancer pain. ICV delivery may be successful if pain is resistant to other treatments. Level of evidence: "B"

A Cochrane review [Abstract] 1 [withdrawn from publication] included 72 uncontrolled trials assessing analgesic efficacy of intracerebroventricular (ICV; 13 trials, 337 patients), epidural (EPI; 31 trials, 1343 patients), and subarachnoid (SA; 28 trials, 722 patients) catheters in cancer patients. Data from uncontrolled studies reported excellent pain relief among 73% of ICV patients compared with 72% EPI and 62% SA. Unsatisfactory pain relief was low in all treatment groups. Persistent nausea, persistent and transient urinary retention, transient pruritus, and constipation occurred more frequently with EPI and SA. Respiratory depression, sedation and confusion were most common with ICV. The incidence of major infection when pumps were used with EPI and SA was zero. There was a lower incidence of other complications with ICV therapy than with EPI or SA.

    References

    • Ballantyne JC, Carwood C, Gupta A et al. WITHDRAWN: Comparative efficacy of epidural, subarachnoid, and intracerebroventricular opioids in patients with pain due to cancer. Cochrane Database Syst Rev 2013;(10):CD005178. [PubMed]

Primary/Secondary Keywords