An implantable pump that delivers pain medication in a slow-release fashion directly into the spinal fluid could greatly improve the pain relief, overall quality of life and survival for cancer patients living in pain, according to an international study completed at Johns Hopkins, the Medical College of Virginia and 25 other medical centers.
Researchers studied more than 200 people with a variety of cancers -- including lung, breast, prostate, colon and pancreatic cancers -- whose pain broke through morphine or other opiate drugs; six were treated at Hopkins. Patients were randomly assigned to either receive an implantable pump delivering medications directly into the spinal fluid or to continue taking pain medicine by mouth.
Results of the study, presented May 21 at the annual meeting of the American Society of Clinical Oncology in Orlando, Fla., revealed that at the end of the six-month study, 54 percent of the pump patients were living, versus 37 percent of those on medical management. In addition, patients on the pump had less pain and fewer side effects from pain drugs, including significantly less fatigue, less constipation or nausea, and improved mental status.
The pump used for the study, about the size and shape of a hockey puck, contains a prescribed amount of drug and is surgically inserted in the abdomen. A small tube reaches from the pump around the waist to deliver medication directly into the spinal fluid. Physicians can tailor the dose for each patient, deciding when and how much medication to release, depending on pain levels. Doctors refill the pump by injecting medication through the abdomen into a tiny opening on the front of the device.
"This challenges our thinking about how to treat cancer pain," says Peter S. Staats, M.D., director of the Division of Pain Medicine at Johns Hopkins and a co-principal investigator for the study. "Normally we give the patients pain medication, and if it doesn't work we'll resort to something else as a last-ditch effort. This suggests that earlier intervention with an approach that minimizes systemic drugs has a significant benefit in a variety of domains. It presents a whole new paradigm in patient care."
The study was funded by Medtronic, Inc.
Co-authors were: George E. Pool, M.P.H., Minneapolis; Patrick J. Coyne, R.N., M.S.N., Richmond, Va.; Thomas J. Smith, M.D., Richmond, Va.; Timothy Deer, M.D., Charleston, W.Va.; Lisa J. Stearns, M.D., Phoenix; Richard L. Rauck, M.D., Winston-Salem, N.C.; Richard L. Boortz-Marx, M.S., M.D., Minneapolis; and Eric Buchser, M.D., Morges, Switzerland.
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