NEUROAXIAL ANALGESIA FOR REFRACTORY CANCER PAIN. EPIDURAL AND INTRATHECAL STRATEGIES IN PALLIATIVE CARE SETTINGS: CLINICAL EVIDENCE, SAFETY, AND IMPLEMENTATION

Abstract

DOI: https://doi.org/10.46296/gt.v9i18.0395

Abstract

Background. Neuraxial analgesia is considered when cancer pain remains uncontrolled despite multimodal therapy or when systemic toxicity becomes unacceptable. Epidural and intrathecal techniques differ in pharmacology, invasiveness, maintenance and feasibility. Objective. To map published evidence on modalities, clinical outcomes, safety and logistical requirements of epidural and intrathecal analgesia for adults with refractory cancer pain in palliative contexts. Methods. A scoping review was conducted following Joanna Briggs Institute guidance and reported with PRISMA-ScR. Eligibility used the population–concept–context framework. Primary studies, secondary syntheses and consensus documents were charted separately. Findings were summarized descriptively; no meta-analysis or formal critical appraisal was performed. Results. The reconstructed evidence map comprised 21 primary reports representing 20 datasets, nine secondary syntheses or health technology assessments, and three consensus documents. Intrathecal evidence was broader but predominantly observational. Verifiable uncontrolled reports described reductions in pain and systemic opioid exposure; a historical randomized trial suggested greater combined improvement in pain and drug toxicity with an implantable intrathecal system. Epidural evidence was smaller and heterogeneous. Safety reporting was inconsistent and palliative outcomes were uncommon. Conclusions. Neuraxial analgesia may provide net benefit for carefully selected patients, but no universally superior route or device was established. Missing numerical selection logs limited review auditability and were not reconstructed.

Keywords: cancer pain; palliative care; epidural analgesia; intrathecal analgesia; drug delivery systems; scoping review.