Palliative care team of the yearBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1861 (Published 15 April 2015) Cite this as: BMJ 2015;350:h1861
- Nigel Hawkes, freelance journalist, London, UK
Interventional cancer pain service
Some cancer patients at the end of life experience pain that cannot be easily controlled by standard analgesics or even strong doses of opiates. More powerful methods exist, such as intrathecal drug delivery systems that deliver drugs direct to the spinal cord through an implanted pump. But these are complex systems delivering powerful drugs, says Alison Mitchell, consultant in palliative medicine in the West of Scotland Interventional Cancer Service. “To extend their use we needed a robust system in place for clinical governance, training staff, picking the right patients, and ensuring their safety.”
The service offers a range of nerve blocking techniques for controlling pain. It was based initially in Glasgow but now extends across the west of Scotland. Patients deemed suitable for intrathecal drug delivery have a catheter inserted into the spine and are then titrated up with drugs. A pump inserted under the skin delivers the appropriate dose and patients can be discharged home, returning fortnightly for the pump to be refilled. Most patients have a limited life expectancy, but the service tries if possible to select patients who will benefit for longer.
Results are excellent, Mitchell says. Pain scores typically fall from 6.8 on a 10 point scale to 3.0 within a week, an improvement sustained for six months. “One patient who had been in terrible pain had the pump installed and three weeks …