473: Effectiveness of intrathecal therapy in chemotherapy induced peripheral neuropathy

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic cancer related pain, Treatment/management

Background and Aims: Chemotherapy induced peripheral neuropathy (CIPN) is found in 68% of patients in the first month after chemotherapy, and then 60 and 30% after 3 and > 6 months respectively (1). The most frequent culprits are vinca alkaloids, paclitaxel, docetaxel, platinum-based antineoplastic drugs, bortezomib, and thalidomide derivatives (1,2). Pharmacological therapy with multimodal therapy that include duloxetine and ligands of the alpha-2-delta subunits of the voltage-gated Ca-channel have been shown to be successful in many patients (3). However, there is a small percentage of patients that do not achieve adequate pain control when using these combinations due to lack of response or side effects limiting quality of life. We have used intrathecal therapy (ITT) to treat this patients. The purpose of this study is to evaluate the long-term effectiveness of ITT in patients with chemotherapy induced peripheral neuropathy that failed optimized multimodal pharmacological therapy.

Methods: IRB approval for the report was obtained by Roswell Park Cancer Institute. This is a retrospective review of prospectively collected data. We retrospectively reviewed the charts of 8 patients who had ITT for CIPN. In order to determine effectiveness, we used all the Comprehensive Pain Assessment Questionnaire (CPAQ) variables at pre-pump implantation, one week, one month, 3 months, 6 months, and 12 months after implantation. Additionally, we used the Beck Inventory to assess patients’ tendency to catastrophize their pain with measures of helplessness, rumination, and magnification.

Results: Of the 8 patients, 5 showed distinct improvement in their pain scores over the course of 12 months. These five patients had a decrease in the total amount of oral opioids and anti-neuropathics. In the graphs that will be presented at the meeting (if accepted), we have included patients’ perception of the level of treatment success as well as the amount of pain they feel (worst, best, current) and that they could live with. Many patients pain levels never reached their acceptable targets, so success scores were predictably low. Moreover, there was no improvement in the 7 parameters evaluated by the CPAQ on psychosocial functioning at any time. Helplessness, rumination, and magnification evaluation did not provide a helpful insight to determine why 3 patients in the group did not score a high level of success, as the rest in this group did.

Conclusions: There was general agreement among the clinic physicians and staff that all our patients had significant improvement from their ITT. However, we found that despite all patients verbally endorsing great analgesia and improved functional capacity, their documented CPAQ scores did not support that impression. Potential reasons include patients who are afraid that medications will be decreased if they document improvement. The CPAQ may be inadequate at accurately capturing the success of treatment and it is very difficult for patients to remember the severity of their pain before the implantation and so they are unable to realize the improvement. Lastly, patients may not be taking the CPAQ seriously and instead are circling the same numbers as always because they feel that is their established disease state. Furthermore, assessment of catastrophizing behaviors did not yield any consistent correlations with success and not success in the therapy.

References: Seretny M, et al. Pain 2014;155:2461
Lavoie Smith EM, et al. Jama 2013;3;309:1359-1367
Hincker A, et al. Pain 2019;160;1835-1846

Presenting Author: Oscar A de Leon-Casasola, MD
Submitting Author: Oscar de Leon-Casasola

Senior Author: Oscar A de Leon-Casasola, MD

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Jennifer Grimmer, DNP, FNP-BC, PMGT-BC: DNP, FNP-BC, PMGT-BC - Roswell Park Comprehensive Cancer Center
• Martha Bentley-McLachlan: RN, BSN, OCN, PMGT-BC - Roswell Park Comprehensive Cancer Center