Intraspinal techniques for pain management

[Olga]

Intraspinal techniques for pain management in cancer patients: a systematic review
Shortcut to: http://tinyurl.com/yb6jtxx .

http://www.springerlink.com/content/k38 ... lltext.pdf .

Abstract
Purpose This systematic review outlines current evidence
regarding the effectiveness of intraspinal techniques for
cancer pain and addresses practical implementation
issues.
Methods A search of electronic databases identified
systematic reviews and randomized controlled trials (RCTs)
evaluating the effectiveness of intraspinal techniques in the
setting of cancer pain. An environmental scan was completed
via the internet to identify practice guidelines and resource
documents addressing organizational and implementation
issues in the delivery of intraspinal analgesia. Elements
reviewed included patient selection, contraindications,
monitoring, aftercare, follow-up, hospital discharge equipment,
health personnel, patient education, and safety.
Main results Three systematic reviews, three consensus
conferences, and 12 RCTs met the inclusion criteria for
evidence of effectiveness. No single systematic review or
consensus conference included all relevant RCTs or
specifically addressed the use of intraspinal techniques for
cancer pain. Six RCTs compared intraspinal techniques
alone or combined with other interventions alone or in
combination, four compared different intraspinal medications,
and two compared different intraspinal techniques. In
general, the evidence supported the use of intraspinal
techniques for cancer pain management. The two main
indications consistently identified were intractable pain not
controlled by other conventional medical routes and/or side
effects from conventional pain management strategies
preventing dose escalation. Reports indicate intraspinal
analgesia is equally or more effective than conventional
medical management and often associated with fewer side
effects. Thirteen resource documents addressed issues
surrounding the delivery of intraspinal analgesia and
program implementation.
Conclusions Intraspinal techniques monitored by an interprofessional
health care team should be included as part of
a comprehensive cancer pain management program.