• Sebastiano Mercadante.
• Main regional center of pain relief and supportive/palliative care, Nutrition (S.M.), La Maddalena Cancer Center, Palermo, Italy; Regional Home care program (S.M.), SAMOT, Palermo, Italy. Electronic address: terapiadeldolore@lamaddalenanet.it.
• J Pain Symptom Manage. 2023 Nov 1; 66 (5): e611e614e611-e614.

BackgroundSpinal analgesia is often claimed as an effective strategy for patients with a poor response to systemic opioids. Despite the optimistic data reported in literature with intrathecal drug delivery systems (IDDS) for cancer pain, a critical analysis showed modest benefit. Indeed, intrathecal therapy may be potent means to be used in a very selected population. However, ability to manage spinal therapy combined with the use of opioids and other drugs in the general perspective of a comprehensive palliative care treatment may allow to resolve refractory cancer pain in a patient with a clinical profile of poor pain prognosis, according to the Edmonton staging system.MethodsA long-term management of patients who underwent different therapeutic approaches, including multiple opioid lines, intrathecal analgesia, and a comprehensive palliative care treatment, is described.ResultsThe case reported describes how the management of cancer pain may be complex, requiring a high level of expertise on using opioids, conversion ratios, different routes, particularly the intrathecal one, as well as providing a comprehensive palliative care treatment.ConclusionsNo evidence-based treatment can be taken into consideration for such extreme conditions, where only experience and knowledge can guide to an effective course of treatment along a period of about six months. Timely therapeutic strategies are needed to be performed in each challenging clinical situation along the course of disease.Copyright © 2023 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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