Refractory cancer pain therapy with intrathecal neurolytic technique—a retrospective tertiary care cancer centre experience

Abstract

Background: The objective of this study is to observe the efficacy of refractory cancer pain therapy with an intrathecal neurolytic technique. Methods: This was a retrospective study of patients who received an intrathecal neurolytic technique between December 2016 and June 2020 at the Department of Anesthesia and Pain Medicine of Shaukat Khanam Memorial Cancer Hospital and Research Center. The data of the patients were retrieved from hospital information system (HIS). Patients were included who had numerical rating score (NRS) ≥8, after monopharmacy or polypharmacy including opioids/neuropathic drugs. Follow-up was conducted by the pain consultant and pain resident post-procedure at 1 week and 4 weeks. Data were documented on a spreadsheet in Microsoft XL and analysed on SPSS version 20. Results: Among 23 patients, numerical rating scale pain score pre-procedure was 8.91 (1.24). It was 3.83 (3.20) and 4.82 (3.41) at 1 and 4 weeks follow-up, respectively. Oral medications were reduced to half of their pre-procedure consumption in 57% of the patients and totally stopped in 30% (n=7) of patients. Complications were reported in 17.4% patients. Hypotension in 13%, and bowel incontinence and leg numbness in 4.3% patients were recorded. Conclusion: This study showed that with appropriate patient selection, understanding of pathophysiology of pain, choice of correct treatment can result in higher success rate. Intrathecal chemical neurolysis can be offered to a subset of patients who have not benefited from other pharmacological therapies.