Intrathecal analgesia for cancer pain: externalised intrathecal catheters.

Dear Editor, We thank the authors for a comprehensive review1 on the role of interventional pain therapies used in cancer pain as well as a informative local audit using the intrathecal catheter (PORT-A-CATH® IT) implantable system (Deltec Inc, USA).2 Our comments are directed at the neuraxial delivery of drugs in both articles. We agree that the most widely accepted indications for intrathecal analgesia in cancer pain are uncontrollable side effects of the systemic pain therapy and inadequate pain relief with parenteral opioids despite dose escalation.3 The authors in the review suggest that epidural analgesia can be used as a trial to assess the effectiveness of pain relief before placement of a permanent implanted intrathecal drug delivery (ITDD) system. On the contrary, we advocate initiating intrathecal analgesia straightaway as intrathecal drug delivery has been shown to produce higher rates of satisfactory pain relief.4 From the practical point of view, this avoids the additional titration step, the more frequent changes of drug reservoirs with epidural infusion and the concomitant risk of epidural fi brosis in the long term. Epidural analgesia infusion is only indicated in