The majority of patients with metastatic cancer experience pain. While appropriate symptom control can be achieved with conventional medication in the majority of patients, nerve blocks, intrathecal drug administration and other interventional techniques are often used in about 15% of all patients1. The administration of drugs directly in the central nervous system has clear theoretical advantages and has been used routinely for many years albeit the clinical efficacy has never been properly established2.

The multicentric randomised clinical trial (RCT) that is presented compares the efficacy of optimal comprehensive medical management (CMM, n=99) with intrathecal drug delivery (IDD, n=101) in term of pain relief and drug-related side effects. The pain intensity decreased significantly with CMM (-39%) as well as with IDD (-52%) (p=.55). Side effects as measured by toxicity scores decreased significantly (p=.004) more with IDD (-50%) than with CMM (-17%). At six months, the survival rate tended to be slightly higher with IDD (59.3%) than with CMM (37.2%) although this was not significant (p=0.6).
In conclusion, IDD tends to improve pain control and significantly decreases drug-related side effects.

References
1. Meuser T, Pietruck C, Radbruch L, Stute P, Lehmann KL, Grond S: Symptoms during cancer pain treatment following WHO-guidelines: A longitudinal follow-up study of symptom prevalence, severity and etiology. Pain 93:247-257, 2001
2. Turk DC: Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain. Clin J Pain 2002; 18: 355-65