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Intrathecal Analgesia — SCE Medical Oncology MCQ

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ModerateSupportive & Palliative OncologyIntrathecal AnalgesiaSCE Medical Oncology

A 65-year-old man with cancer pain refractory to high-dose systemic opioids is referred for consideration of intrathecal drug delivery. What is the primary advantage of intrathecal analgesia?

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Correct answer: B — Intrathecal administration delivers drugs directly to spinal opioid receptors, requiring ~1/300th of the oral morphine dose, dramatically reducing systemic side effects while maintaining analgesia

Intrathecal drug delivery (IDD) via implanted pump delivers opioids (morphine, hydromorphone) ± local anaesthetic (bupivacaine) ± ziconotide directly to the cerebrospinal fluid. The dose conversion ratio is approximately 1:300 (oral morphine: intrathecal morphine), dramatically reducing systemic side effects (drowsiness, constipation, nausea). IDD is considered for patients with cancer pain refractory to optimal systemic analgesia or those with intolerable opioid side effects despite good pain control. Specialist pain/palliative care referral is required.

Reference: NICE CG140 Opioids in palliative care; ESMO 2024 Pain Management; British Pain Society IDD guidelines