Objectives

Management of refractory cancer-associated pain can be particularly challenging. Regional anesthesia is an alternative modality to treat acute and chronic refractory pain. Intrathecal (IT) drug delivery of opioids and other adjuncts has been used to treat refractory cancer-associated pain. This method has been shown to be relatively safe and effective, often associated with fewer systemic side effects when compared to oral or IV opioid administration. While intrathecal drug delivery systems (IDDS) are regularly used in the adult cancer population for the treatment of refractory, chronic pain, there is limited evidence of similar use in the pediatric setting.

Materials and Methods

We performed a systematic review using conventional Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology to identify studies reporting IT drug delivery for the treatment of pediatric cancer-related pain. The primary outcome was satisfaction with analgesia categorized as “satisfactory” or “unsatisfactory.” Functional benefits, previous systemic pharmaceutical interventions, previous non-IT regional interventions, indication for IT drug delivery, IT drugs used, and method of delivery were collected.

Results

A total of 11 studies were identified, describing 16 patients with cancer-related pain treated with IT drug delivery. The average age of the cohort was 12.25 years, with ages ranging from 3 to 19 years. Most patients were adolescent (10/16). All patients had cancer diagnoses, with most patients suffering from solid tumor pain (14/16). Nearly all patients achieved satisfactory analgesia through IT drug delivery (15/16) and most reported functional benefits in addition to analgesia (13/16). Majority received IT drugs via external catheters (9/16). One severe complication of respiratory depression was reported, which resolved following naloxone administration.

Conclusions

There exist children with cancer whose pain is refractory to the standard approaches and may benefit from IT drug delivery. The existing data, although limited and of low tier evidence, suggest that IT drug delivery has been effective in the pediatric cancer population.

中文翻译：

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鞘内给药治疗儿童癌症相关慢性疼痛

目标

难治性癌症相关疼痛的治疗尤其具有挑战性。区域麻醉是治疗急性和慢性难治性疼痛的另一种方法。阿片类药物和其他辅助剂的鞘内 (IT) 药物输送已用于治疗难治性癌症相关疼痛。这种方法已被证明相对安全有效，与口服或静脉注射阿片类药物相比，通常具有较少的全身副作用。虽然鞘内给药系统 (IDDS) 经常用于成人癌症人群治疗难治性慢性疼痛，但在儿科环境中类似使用的证据有限。

材料和方法

我们使用系统评价的传统首选报告项目和荟萃分析方法进行了系统评价，以确定报告 IT 药物输送用于治疗儿科癌症相关疼痛的研究。主要结局是对镇痛的满意度，分为“满意”或“不满意”。收集功能益处、既往系统药物干预、既往非 IT 区域干预、IT 药物输送适应症、使用的 IT 药物和输送方法。

结果

总共确定了 11 项研究，描述了 16 名接受 IT 药物输送治疗的癌症相关疼痛患者。该队列的平均年龄为12.25岁，年龄范围为3岁至19岁。大多数患者是青少年（10/16）。所有患者均被诊断为癌症，其中大多数患者患有实体瘤疼痛 (14/16)。几乎所有患者都通过 IT 药物输送实现了满意的镇痛 (15/16)，并且大多数报告除镇痛外还获得了功能益处 (13/16)。大多数人通过外部导管接受 IT 药物 (9/16)。据报道，出现了一种严重的呼吸抑制并发症，该并发症在纳洛酮给药后得到缓解。

结论

有些癌症儿童的疼痛无法通过标准方法缓解，但 IT 药物输送可能会使其受益。现有数据虽然有限且证据级别较低，但表明 IT 药物输送对儿童癌症人群有效。