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ITDD for Cancer Brachial Plexus Pain — FRCA Final MCQ

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HardPain MedicineITDD for Cancer Brachial Plexus PainFRCA Final

A 65-year-old woman with metastatic breast cancer has severe neuropathic pain in the right arm from brachial plexus infiltration. She is on maximum doses of gabapentin, amitriptyline, and oxycodone. Her pain is 9/10 and severely impacts quality of life. Which interventional technique may provide targeted pain relief?

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Correct answer: A — Intrathecal drug delivery system

For refractory cancer pain in the upper limb from brachial plexus infiltration, an intrathecal drug delivery system (ITDD) with morphine ± bupivacaine ± clonidine provides targeted spinal cord-level analgesia. The ITDD delivers drugs directly to the CSF at the relevant spinal segments (C5-T1 for arm pain), achieving effective analgesia at a fraction of the systemic dose. NICE TA65 supports ITDD for intractable cancer pain. Brachial plexus neurolysis carries risk of motor loss. Coeliac plexus block targets abdominal visceral pain.

Reference: NICE – 2003 – TA65 Intrathecal drug delivery; Faculty of Pain Medicine – 2021 – Cancer pain interventions