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Intrathecal Pump Implantation Decision — SCE Palliative Medicine MCQ

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HardPain ManagementIntrathecal Pump Implantation DecisionSCE Palliative Medicine

A 70‑year‑old man with advanced gastric cancer and severe epigastric pain has failed maximal systemic analgesia and a coeliac plexus block. An intrathecal pump trial with morphine and bupivacaine provides 80% pain relief. What is the next step?

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Correct answer: D — Proceed to implantation of a permanent intrathecal drug delivery system

The correct answer is D. Under NHS England policy, intrathecal pumps are commissioned for severe cancer pain when patients are appropriately selected following a favourable trial. In this case, 80% analgesia meets that threshold. The British Pain Society’s 2024 guidance supports that a successful trial justifies proceeding to implantation. Option A is invalid—oral bupivacaine is not an established analgesic. Option B abandons an effective intervention in refractory pain. Option C is suboptimal—epidural therapy is less effective, short‑term and associated with more complications. Option E is unnecessary, as one successful trial suffices and further trials only delay care and increase risk.

Reference: NHS England Clinical Commissioning Policy: Intrathecal Pumps for Treatment of Severe Cancer Pain (2015); British Pain Society guidance on Intrathecal Drug Delivery (2024)