+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Prospective Observational Study of Patient-Controlled Intrathecal Analgesia: Impact on Cancer-Associated Symptoms, Breakthrough Pain Control, and Patient Satisfaction

Prospective Observational Study of Patient-Controlled Intrathecal Analgesia: Impact on Cancer-Associated Symptoms, Breakthrough Pain Control, and Patient Satisfaction

Regional Anesthesia and Pain Medicine 40(4): 369-375

Although data exist for the efficacy of intrathecal therapy (ITT), there are no prospective data on patient-controlled intrathecal analgesia (PCIA) in refractory cancer pain. This study examines the effect of PCIA on cancer symptom scores, patient satisfaction, and analgesic efficacy with an emphasis on breakthrough pain (BTP). Ninety-eight patients with refractory cancer pain prospectively completed questionnaires including the MD Anderson Symptom Inventory and a BTP survey before and after the implantation of an intrathecal pump. Fifty-eight patients were included in the study group. Average "worst" pain scores decreased from 8.32 (SD, 1.73) pre-ITT to 4.98 (SD, 2.92) post-ITT, P < 0.001. Severe pain (numerical rating score ≥7) decreased from 84.2% to 35.2% (P < 0.001). Mean daily morphine equivalent dosing decreased from 805.3 mg/d to 128.2 mg/d, with 65.5% of patients discontinuing all nonintrathecal opioids. The mean MD Anderson Symptom Inventory symptom severity score decreased from 4.98 to 3.72 (P < 0.0001), and the symptom interference score from 6.53 to 4.37 (P < 0.001). Pain reduction was 46.8% with pre-ITT breakthrough medications and 65.2% with PCIA (P < 0.001). Median time to onset was 30 minutes with pre-ITT breakthrough medications and 10 minutes with PCIA (P < 0.001). Patient-controlled intrathecal analgesia, compared with conventional BTP medications, was "a lot better" in 60.7% and "a little better" in 28.6%. Overall pain control satisfaction was also improved, with 78.2% "a lot better" and 10.9% "I have no pain." In patients with poorly controlled cancer pain, PCIA is associated with improved pain control, improved cancer-related symptoms, and high satisfaction. Compared with conventional BTP regimens, PCIA provides superior analgesia and a 3-fold faster onset of action.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 058645585

Download citation: RISBibTeXText

PMID: 25923819

DOI: 10.1097/AAP.0000000000000251

Related references

Influence of patient-controlled epidural analgesia versus patient-controlled intravenous analgesia on postoperative pain control and recovery after gastrectomy for gastric cancer: a prospective randomized trial. Gastric Cancer 16(2): 193-200, 2013

A prospective randomized trial comparing patient-controlled epidural analgesia to patient-controlled intravenous analgesia on postoperative pain control and recovery after major open gynecologic cancer surgery. Gynecologic Oncology 114(1): 111-116, 2009

The control of severe cancer pain by continuous intrathecal infusion and patient controlled intrathecal analgesia with morphine, bupivacaine and clonidine. Pain 78(3): 217-220, 1998

Comparison of the efficacy of dexmedetomidine plus fentanyl patient-controlled analgesia with fentanyl patient-controlled analgesia for pain control in uterine artery embolization for symptomatic fibroid tumors or adenomyosis: a prospective, randomized study. Journal of Vascular and Interventional Radiology 24(6): 779-786, 2014

Patient perspectives of patient-controlled analgesia (PCA) and methods for improving pain control and patient satisfaction. Regional Anesthesia and Pain Medicine 38(4): 326-333, 2014

Patient-controlled analgesia with piritramide for postoperative pain relief in general surgery: a prospective observational study.. Schmerz 7(1): 25-30, 1993

Patient-controlled analgesia (PCA) for postoperative pain relief. A prospective observational study for evaluating the technology in a ward routine. Der Chirurg; Zeitschrift für Alle Gebiete der Operativen Medizen 64(10): 802-808, 1993

Safety profile of intravenous patient-controlled analgesia for breakthrough pain in cancer patients: a case series study. Supportive Care in Cancer 22(3): 795-801, 2014

Comparison of the Efficacy of Dexmedetomidine plus Fentanyl Patient-controlled Analgesia with Fentanyl Patient-controlled Analgesia for Pain Control in Uterine Artery Embolization for Symptomatic Fibroid Tumors or Adenomyosis A Prospective, Randomized St. 2013

Patient controlled analgesia the comparison of pain control and patient satisfaction and side effects in intra abdominal surgery. Pain (SUPPL 5): S148, 1990

Intrathecal narcotic analgesia ita vs patient controlled analgesia pca for postoperative pain control after major abdominal surgery. Pain (SUPPL 5): S142, 1990

Clinical staff resource use with intravenous patient-controlled analgesia in acute postoperative pain management: results from a multicenter, prospective, observational study. Journal of Perianesthesia Nursing 22(4): 243-255, 2007

Patient satisfaction between remifentanil patient-controlled analgesia and epidural analgesia for labor pain. Acta Obstetricia et Gynecologica Scandinavica 94(9): 1014-1021, 2015

Patient Satisfaction Between Remifentanil Patient-controlled Analgesia and Epidural Analgesia for Labor Pain. Obstetric Anesthesia Digest 36(3): 159-160, 2016

Movement-evoked breakthrough cancer pain despite intrathecal analgesia: a prospective series. Acta Anaesthesiologica Scandinavica 55(9): 1139-1146, 2012