Impact of intrathecal targeted drug delivery (ITDD) on oral morphine equivalents and pain scores in advanced pancreatic cancer pain.

Abstract

686 Background: Pancreatic cancer accounts for approximately 3% of all cancers and affects ~64,000 adults in the United States each year. Seventy five percent of patients present with abdominal pain, leading to diagnosis. This is one of the most painful cancers, with pain severity strongly correlating to prognosis. Severe intractable abdominal pain negatively impacts quality of life. Traditionally, opioids have been used as the first line agent for the treatment of severe abdominal pain. However, opioids carry significant risk and often unwarranted side effects. With escalating doses to treat refractory pain there is also potential for unintentional overdose. Intrathecal targeted drug delivery (ITDD) provides pain medications directly to the intrathecal space limiting systemic side effects. Our study aimed to determine the impact ITDD has on pain scores as well as the amount of systemic opioid needed in patients with advanced pancreatic cancer. Methods: A retrospective review was conducted on 217 advanced cancer patients that underwent ITDD placement from March 2019 through July 2024. Thirty- five patients with a diagnosis of pancreatic cancer met inclusion criteria. Pain scores and oral morphine equivalent (OME) use was evaluated at baseline (prior to ITDD), at 1 month and 3 months post ITDD implant. A numeric scale of 0-10 was used to determine pain scores, while a comprehensive chart review and patient response was used to determine OME use. Results: We found that post ITDD placement, pain scores were reduced on average by 4.55 points at 1month and 4 points at 3-months after implantation. This was statistically significant with a two-paired t-test analysis (p <0.05). Post ITDD placement, there was a 96.7% reduction in OME at 1-month (p <0.005) and 98.1% reduction in OME at 3 months (p <0.04). Conclusions: Despite the small sample size of patients, ITDD showed a significant reduction in pain scores and OME use compared to baseline with systemic opioid use only in patients with advanced pancreatic cancer. This reduction appeared to be maintained for 3 months post ITDD placement. Further studies conducted on a larger sample size would be beneficial to demonstrate statistical outcomes of ITDD therapy on pain scores and OME use.