Figure 1.

Pain reduction with intrathecal (IT) opioids as the first agent in pump in patients with cancer pain [29]. Patients with cancer pain received comprehensive medical management (CMM; all pain therapy except spinally administered medications, cordotomy, or other similar neurosurgical interventions) or IT morphine or hydromorphone therapy for four weeks. After four weeks of treatment, patients who received IT opioids had a nonsignificantly greater reduction in pain, as measured on a continuous visual analog scale ranging from 0 (no pain) to 10 (worst pain imaginable), than those who received CMM. Figure created with data from: Smith TJ, Staats PS, Deer T, et al. Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: Impact on pain, drug-related toxicity, and survival. J Clin Oncol 2002;20(19):4040–9 [29]. CMM = comprehensive medical management; IDDS = implantable drug delivery system; VAS = visual analog scale.