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Peer-reviewedCC BYActa oncologica (Stockholm, Sweden)

Continuous intrathecal therapy for refractory cancer pain: A systematic review and meta-analysis focusing on partially implanted devices.

  • Mohammadhossein Radafshar1
  • Maria Schelin2
  • Elisabeth Bondesson3
  • Sofia Löfvendahl4
  • Eric Ahl5
  • Sven Oredsson5
  • Mikael Segerlantz6
6 affiliations
  1. 1Institute for Palliative Care, Department of Clinical Sciences Lund, Lund University and Region Skåne, Lund, Sweden; Department of Palliative Care and Advanced Home Health Care, Region Skåne, Lund, Sweden. [email protected].
  2. 2Institute for Palliative Care, Department of Clinical Sciences Lund, Lund University and Region Skåne, Lund, Sweden.
  3. 3Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden; HTA South, Department of Research, Development, Education and Innovation, Skåne University Hospital Lund, Lund, Sweden.
  4. 4HTA South, Department of Research, Development, Education and Innovation, Skåne University Hospital Lund, Lund, Sweden; The Swedish Institute for Health Economics, Lund, Sweden.
  5. 5HTA South, Department of Research, Development, Education and Innovation, Skåne University Hospital Lund, Lund, Sweden.
  6. 6Institute for Palliative Care, Department of Clinical Sciences Lund, Lund University and Region Skåne, Lund, Sweden; Department of Palliative Care and Advanced Home Health Care, Region Skåne, Lund, Sweden.
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Abstract

Context

Conventional pain therapies sometimes fail in patients with severe neuropathic pain or bone metastases. Intrathecal therapy provides an alternative but is resource-intensive, technically demanding and costly.Objective

To compare the advantages and limitations of partially implanted devices (PIDs) versus conventional medical management or totally implanted devices (TIDs) in adults with cancer-related pain.Methods

A systematic literature review up to September 2024 was conducted, with an updated search performed in August 2026. Eligible studies included those on adults with refractory cancer pain receiving PID intrathecal therapy compared with conventional therapy, and comparative studies evaluating PIDs versus TIDs. Pain intensity was analysed using a meta-analysis; a synthesis without meta-analysis was used for other outcomes.Results

Of the 1,102 records, 15 were included, evaluating pain intensity, systemic opioid dose, quality of life (QoL), depression/anxiety, functional capacity and complications in PID-treated patients. A meta-analysis of pain intensity at 4 weeks showed statistically significant reduction with intrathecal therapy, which also reduced opioid use and improved QoL. Complication rates were lower than in conventional therapy. Investigations of depression/anxiety and functional capacity were limited, with inconsistent findings. Certainty of evidence was moderate for pain intensity and QoL; low for opioid dose, depression/anxiety and complications; and very low for functional capacity.Conclusions

Intrathecal therapy for refractory cancer pain with PIDs provides superior pain relief and improved QoL compared with the conventional therapy in patients with refractory cancer pain. Evidence for psychological and functional outcomes remains limited. Overall certainty of evidence is low to moderate, but findings support intrathecal therapy as a clinically meaningful option for selected patients.

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Cite

BibTeXRIS
BibTeX
@article{radafshar2026continuous,
  title = {{Continuous intrathecal therapy for refractory cancer pain: A systematic review and meta-analysis focusing on partially implanted devices.}},
  author = {Mohammadhossein Radafshar and Maria Schelin and Elisabeth Bondesson and Sofia Löfvendahl and Eric Ahl and Sven Oredsson and Mikael Segerlantz},
  journal = {Acta oncologica (Stockholm, Sweden)},
  year = {2026},
  month = oct,
  doi = {10.2340/1651-226x.2026.45778},
  url = {https://europepmc.org/article/MED/42861943},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Continuous intrathecal therapy for refractory cancer pain: A systematic review and meta-analysis focusing on partially implanted devices.
AU  - Mohammadhossein Radafshar
AU  - Maria Schelin
AU  - Elisabeth Bondesson
AU  - Sofia Löfvendahl
AU  - Eric Ahl
AU  - Sven Oredsson
AU  - Mikael Segerlantz
PY  - 2026
DA  - 2026/10/12
JO  - Acta oncologica (Stockholm, Sweden)
DO  - 10.2340/1651-226x.2026.45778
UR  - https://europepmc.org/article/MED/42861943
AB  - Context  Conventional pain therapies sometimes fail in patients with severe neuropathic pain or bone metastases. Intrathecal therapy provides an alternative but is resource-intensive, technically demanding and costly.Objective  To compare the advantages and limitations of partially implanted devices (PIDs) versus conventional medical management or totally implanted devices (TIDs) in adults with cancer-related pain.Methods  A systematic literature review up to September 2024 was conducted, with an updated search performed in August 2026. Eligible studies included those on adults with refractory cancer pain receiving PID intrathecal therapy compared with conventional therapy, and comparative studies evaluating PIDs versus TIDs. Pain intensity was analysed using a meta-analysis; a synthesis without meta-analysis was used for other outcomes.Results  Of the 1,102 records, 15 were included, evaluating pain intensity, systemic opioid dose, quality of life (QoL), depression/anxiety, functional capacity and complications in PID-treated patients. A meta-analysis of pain intensity at 4 weeks showed statistically significant reduction with intrathecal therapy, which also reduced opioid use and improved QoL. Complication rates were lower than in conventional therapy. Investigations of depression/anxiety and functional capacity were limited, with inconsistent findings. Certainty of evidence was moderate for pain intensity and QoL; low for opioid dose, depression/anxiety and complications; and very low for functional capacity.Conclusions  Intrathecal therapy for refractory cancer pain with PIDs provides superior pain relief and improved QoL compared with the conventional therapy in patients with refractory cancer pain. Evidence for psychological and functional outcomes remains limited. Overall certainty of evidence is low to moderate, but findings support intrathecal therapy as a clinically meaningful option for selected patients.
SN  - 0284-186X
SN  - 1651-226X
ER  -