Continuous intrathecal therapy for refractory cancer pain: A systematic review and meta-analysis focusing on partially implanted devices.
Mohammadhossein Radafshar, Maria Schelin, Elisabeth Bondesson et al.
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In 30 seconds
This systematic review and meta-analysis assessed partially implanted intrathecal devices (PIDs) for adults with refractory cancer-related pain, comparing them with conventional medical management and, in comparative studies, totally implanted devices. Across 15 included studies, pooled pain intensity at 4 weeks was significantly lower with intrathecal therapy. The review also found reduced systemic opioid use and improved quality of life, while reported complication rates were lower than with conventional therapy. Evidence certainty ranged from moderate for pain intensity and quality of life to very low for functional capacity.
Key findings
- Meta-analysis found a statistically significant reduction in pain intensity at 4 weeks with intrathecal therapy.
- Intrathecal therapy was associated with reduced opioid use and improved quality of life compared with conventional therapy.
- Complication rates were lower than with conventional therapy, but certainty of evidence for complications was low.
- Evidence on depression, anxiety and functional capacity was limited and inconsistent.
Why it matters
Refractory cancer pain can remain difficult to manage with conventional therapies. This review suggests that PID-based intrathecal therapy may provide better pain relief and quality of life, while potentially reducing opioid use. However, evidence is less certain for complications and other patient-centred outcomes, so the overall findings support consideration in selected patients rather than broad conclusions about all outcomes.
What to keep in mind
The evidence base comprised 15 studies, and certainty varied from moderate to very low. Findings for psychological and functional outcomes were limited or inconsistent.