REVIEW

Intrathecal Opioid Pump in the Treatment of Pain in Oncologic Patients: case series and literature review

Bomba de Opioide Intratecal no Tratamento da Dor em Pacientes Oncológicos: série de casos e revisão de literatura

  • Rafael Caiado Caixeta Vencio (1)    Rafael Caiado Caixeta Vencio (1)
  • André Akira Ramos Takahashi (2)    André Akira Ramos Takahashi (2)
  • Paulo Eduardo Albuquerque Zito Raffa (3)    Paulo Eduardo Albuquerque Zito Raffa (3)
  • Maria Clara Cardoso Seba (2)    Maria Clara Cardoso Seba (2)
  • Henrique Nicola Santo Antonio Bernardo (2)    Henrique Nicola Santo Antonio Bernardo (2)
  • Raphael Vinícius Gonzaga Vieira (4)    Raphael Vinícius Gonzaga Vieira (4)
  • César Cozar Pacheco (4)    César Cozar Pacheco (4)
  • Paulo Henrique Pires de Aguiar (5)    Paulo Henrique Pires de Aguiar (5)
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Resumo

Introdução: A dor intratável em pacientes oncológicos reduz a qualidade de vida e aumenta a utilização de opioides orais sem eficácia. Assim, a bomba de opioide intratecal torna-se uma opção, permitindo uma redução na dose de medicamentos orais e na mortalidade, ao mesmo tempo em que aumenta a eficácia do tratamento. Método: Revisão sistemática da literatura na base de dados PubMed buscando por “intrathecal opioid” e “cancer pain”. Foram incluídos os principais pontos para o acompanhamento de um paciente oncológico que foi submetido ao implante de bomba de opioide intratecal. Resultados: Caso 1: paciente masculino, 63 anos de idade, câncer de próstata com metástase óssea, associada a dor óssea refratária pré-operatória 7/10 e pós-operatória 3/10 (escala de estimativa numérica). Caso 2: paciente feminino, 21 anos, rabdomiossarcoma na mandíbula esquerda, dor refratária 7/10 no território do nervo mandibular e 3/10 (escala de estimativa numérica) no pós-operatório. Caso 3: paciente masculino, 31 anos, câncer anal, dor intensa anorretal e nos membros inferiores, refratária a um estranho bloqueio de gânglio, sem melhora após o procedimento. Discussão: A refratariedade a outras terapias medicamentosas e o ensaio de terapias intratecais devem ser considerados antes do procedimento. A casuística apresentada mostra o potencial do tratamento, que foi capaz de diminuir em mais de 50% a intensidade da dor em dois dos pacientes. Entretanto, a técnica possui limitações, sendo que um dos pacientes relatados não conseguiu melhora sintomática mesmo com o uso de morfina intratecal. Conclusão: O implante de uma bomba de opioide intratecal é uma opção com grande potencial terapêutico na dor refratária.

Palavras-chave

Opioide Intratecal; Dor Oncológica; Tratamento oncológico

Abstract

Introduction: Intractable pain in cancer patients reduces the quality of life and increases the use of oral opioids without effectiveness in treatment. Therefore, the intrathecal opioid pump becomes an option, allowing a reduction in drug dose and mortality while increasing treatment efficacy. Method: Systematic review of literature in PubMed searching for “intrathecal opioid” and “cancer pain”. The main points for the follow-up of an oncologic patient, who underwent an intrathecal opioid pump implantation were included. Results: Case 1: Male patient, 63 years old, prostate cancer with bone metastasis and refractory bone pain preoperatively 7/10 and postoperatively 3/10 (NRS). Case 2: Female patient, 21 years old, rhabdomyosarcoma in the left mandible, refractory pain 7/10 in mandibular nerve territory and 3/10 (NRS) post-procedure. Case 3: Male patient, 31 years old, anal cancer, intense anorectal and lower limb pain refractory to odd ganglion block, with no improvement after the procedure. Discussion: Refractoriness to other drug therapies and the trial of intrathecal therapies should be considered before the procedure. The case series presented shows the potential of the treatment, which was able to reduce pain intensity by more than 50%, in two patients. However, the technique has limitations, and one of the reported patients did not achieve symptomatic improvement even with the use of intrathecal morphine. Conclusion: The implantation of an intrathecal opioid pump is undoubtedly an option with great therapeutic potential in refractory pain.

Keywords

Intrathecal Opioids; Cancer Pain; Oncologic treatment

References

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1Medical student, Pontifical Catholic University of Goiás (PUC-GO), Goiânia, GO, Brazil.

2Medical student, ABC Medical School (FMABC), Santo André, SP, Brazil.

3Medical student, Catanduva Medicine School (FAMECA-UNIFIPA), Catanduva, SP, Brazil.

4MD, Department of Neurosurgery, Santa Paula Hospital, São Paulo, SP, Brazil.

5MD, PhD, Department of Molecular Biology, ABC Medicine School (FMABC), Santo André, SP, Brazil.

 

Received Aug 9, 2022
Corrected Aug 15, 2022
Accepted Sep 1, 2022

JBNC  Brazilian Journal of Neurosurgery

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