T: Ok, to begin with, I’d like to ask you if you have any idea on what intrathecal analgesia (IA) is about?

SN: Frankly, my knowledge is very lacking on the subject.

T: Well, basically, IA is a type of pain control, which is also called spinal anesthesia. In other words, pain medicine is injected around the spinal cord to control pain from medical procedures and long-term pain from illnesses, such as cancer.

SN: What are the objectives of this therapeutic procedure?

T: To better control pain and for a better quality of life for the patient.

SN: Are there any specific indications to giving intrathecal analgesia?

T: Yes. The procedure must be validated by a multidisciplinary team trained and specialized in the technique, in case of intense chronic pain refractory to opiate or non-opiate treatments administered by the systemic route; or when side effects related to the analgesic treatment impair the patient’s quality of life. For this, intrathecal analgesia may be indicated earlier for pain whose localization is known to be rebellious to usual treatments, like abdominopelvic pain in certain cancers (uterus, rectum, etc.), pain in pancreatic cancers or Pancoast Tobias syndrome (reflecting a malignant neoplasm of the pulmonary apex).

SN: What should be taken into account for this procedure?

T: First of all, given the efficacy of the intrathecal analgesia, we might always propose this pain care technique to anticipate certain situations early in the treatment procedure, without waiting to check if other pain-care procedures fit or not. This means that we should consider this pain treatment during care and not in the palliative care phase.

SN: Ok. And what about the nurse’s role here?

T: They can either care for in- or discharged patients. In either case, they have to be knowledgeable in filling in and using the analgesia pump and patient follow-up. In this sense, also, they educate patients on how to use the Patient-Controlled Analgesia pump.

SN: But then, how is the procedure carried out?

T: Drugs are injected directly into the cerebrospinal fluid via a catheter implanted in the subarachnoid space. The analgesics are delivered as close as possible to the medullary receptors involved in the transmission of the nociceptive message, so that we can reduce the doses and therefore the associated side effects.

SN: Ok. Now all these things being equal and considered, there must then be some side effects, as you’ve just mentioned, like for any treatment, isn’t it?

T: Intracranial hypertension is the only absolute contraindication. The other adverse effects are relative, evaluated on a case-by-case basis according to the benefit/risk balance. Therefore, we might think of aplasia; carcinomatous meningitis; epiduritis; any infectious process, which must be checked before the insertion of a catheter; anticoagulant treatment; ascites for an implanted pump but not for a catheter connected to an external pump; or any obstacle to the circulation of cerebrospinal fluid.