Targeted drug delivery
Cancer pain
Patient selection and clinical evidence
Helping patients manage cancer pain with targeted drug delivery
Targeted drug delivery is effective in reducing or eliminating the need for systemic opioids when used to treat cancer-related pain.1
SynchroMed™ implantable infusion system
The SynchroMed™ III implantable infusion system delivers prescribed medication directly into the intrathecal space, thereby bypassing the blood-brain barrier. As result, only a fraction of the oral dose is needed to sustain pain relief.2
Patient selection and referral guidelines: targeted drug delivery for cancer-related pain
For many cancer patients, oral analgesics may be adequate; however, those cancer patients with intractable pain who meet any of the criteria listed below may be appropriate for more advanced pain management techniques including targeted drug delivery (TDD) using intrathecal opioids. These patients may be candidates for targeted drug delivery (TDD) using intrathecal opioids to control pain.
Pending a successful intrathecal morphine trial, a permanent intrathecal catheter and Medtronic SynchroMed™ III programmable pump may help control your patients’ pain.
Selection guidelines: targeted drug delivery for cancer patients
Cancer patients with intractable pain who meet any of the criteria below may be candidates targeted drug delivery with SynchroMed™ III
- Symptoms of pain due to advanced stage cancer at presentation, with a minimum life expectancy of >3 months.3,4,8,9
- Refractory to conventional pain management because of intractable drug adverse effects or unsatisfactory analgesia.3,4,8,9
- Visual analog scale (VAS) of ≥ 5, despite 200 mg/day of oral morphine or the analgesic equivalent.†,3,8,9
Consider patients on lower doses if opioid side effects are refractory to conservative treatment and severe enough to prevent upward titration3,8,9
Note: It is important to consider increased assessment and referral vigilance for women,5–7,10 minorities,5–7,11 and the elderly,5,6,11 who have been shown to be at increased risk for inadequate analgesia.
Clinical outcomes
Refractory cancer pain
Study highlights
Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain:3
- Prospective, multicenter, randomized
- 200 patients with advanced cancer and refractory pain
- Patients randomly assigned to receive comprehensive medical management (CMM) or intrathecal drug delivery (IDDS) plus CMM, 100 per arm
- Intrathecal drug delivery was delivered by the SynchroMed™ programmable infusion system
- Entry criteria included visual analog scale (VAS) pain score of ≥5 on a 0–10 scale despite 200 mg/day of oral morphine or its equivalent, or lower doses with intolerable side effects
- Demographic and clinical characteristics were well balanced.