[Causes of inadequate analgesia and management strategies following semi-implantable intrathecal drug delivery system implantation in patients with cancer pain].

This retrospective study summarized the clinical management of cancer pain patients who experienced inadequate analgesia following the implantation of a semi-implantable intrathecal drug delivery system (IDDS) at the Affiliated Cancer Hospital of Zhengzhou University between January 2020 and December 2022. The causes of inadequate analgesia and management strategies were analyzed. A total of 8 patients were included, comprising 4 males and 4 females, with a median age M(Q1, Q3) of 56.0 (42.8, 62.0) years. The time to onset of poor analgesic efficacy after IDDS implantation was 0.33 (0.25, 0.34) months. After individualized adjustment of treatment strategies, the total duration of IDDS analgesia was 5.10 (4.00, 7.42) months. The main reasons for inadequate analgesia included high-dose opioid tolerance, mixed types of pain with hyperalgesia, central toxicity of intrathecal analgesics, and rapid tumor progression. Strategies such as appropriately increasing the intrathecal drug dosage, opioid rotation, combination with adjuvant analgesics, multimodal analgesia, efforts to control tumor progression, and early application of intrathecal analgesia contributed to achieving more optimal analgesic outcomes.