Intrathecal Infusion in Cancer Pain Surgery.

BACKGROUND: Cancer pain is a complex and multifactorial phenomenon that significantly impairs quality of life, particularly in advanced stages of malignancy. Although systemic pharmacologic therapies remain the cornerstone of management, a substantial proportion of patients experience refractory pain or intolerable side effects. Intrathecal drug delivery (ITDD) offers a targeted method of analgesia by administering medications directly into the cerebrospinal fluid, enabling effective pain control at lower doses while minimizing systemic toxicity.

SUMMARY: This review explores the physiological mechanisms underlying cancer pain, the rationale for intrathecal therapy, and the pharmacological profiles of commonly used intrathecal agents. Patient selection criteria, timing of therapy integration, and the technical aspects of device implantation are discussed in detail. Although ITDD significantly improves pain control and quality of life, potential complications, mechanical, pharmacological, infectious, and surgical, necessitate careful procedural planning, rigorous follow-up, and multidisciplinary management.

KEY MESSAGES: Intrathecal drug delivery is an effective modality for managing refractory cancer pain and can significantly enhance patient quality of life. Early integration into the cancer care continuum, rather than reserving ITDD as a last resort, may provide superior symptom control. Careful patient selection, individualized pharmacologic regimens, and precise surgical technique are critical to minimizing complications and optimizing outcomes. Further research is needed to refine drug combinations, improve device technology, and define best practices for early intervention strategies.