Study Shows Intrathecal Bupivacaine Effective for Long-Term Cancer Pain Treatment

Study Shows Intrathecal Bupivacaine Effective for Long-Term Cancer Pain Treatment

Boston-Patients suffering from cancer pain refractory to systemic opioids may find relief in an unlikely source, according to a pilot study by Swedish researchers: intrathecal bupivacaine. They concluded that the therapy can be effectively used for long-term pain management in these individuals with little increase in dose and few of the side effects that often accompany opioid-related treatment.

“Treating cancer pain with morphine is often effective, but it’s not without its problems,” said Anders Wincent, MD, a senior consultant at the Karolinska University Hospital in Stockholm. “Previously we found there was no analgesic benefit to adding morphine to intrathecal bupivacaine in severe cancer-related pain [Int J Clin Pharmacol Ther 2017;55(6):525-532]. So in this study we wanted to see if we could address this pain only with intrathecal bupivacaine.”

Putting It to the Test

To help answer this question, Dr. Wincent and his co-investigator Karl-Fredrik Sjolund, MD, PhD, enrolled 30 adult patients (17 women; median age, 55 years) with cancer-related pain, who presented to the institution between November 2013 and June 2017, into the longitudinal case series; each was receiving systemic opioid therapy. All patients were started on an intrathecal bupivacaine infusion of 2 mg/mL; flow rates and subsequent bolus doses were titrated as necessary. The catheter tip was positioned cranially to the individual’s most painful dermatome; catheter tip position was verified with fluoroscopy. After subcutaneous tunneling, the catheter was attached to a subcutaneous port and connected to an external pump.

Before intrathecal bupivacaine therapy, the participants completed a pain-related questionnaire. Follow-up was performed by nurses via a structured telephone interview with the patients, their families or staff at a palliative care facility or hospital. Pain intensity at rest and during activity was measured using the numerical rating scale (NRS); other tools included the short form of the Brief Pain Inventory, the revised Edmonton Symptom Assessment Scale and ECOG Performance Status.

Motor function was graded with the modified Bromage scale (0-3); daily systemic opioid data were extracted from electronic health records. Patient data were collected on the day before and day of catheter insertion; one day after catheter insertion; on days 3, 7, 14, 21 and 28; and once monthly thereafter.