Giving new hope to the patients experiencing severe chronic cancer pain, a Chennai-based Neurosurgeon Dr R Ramnarayan, after a decade's service in UK, has come out with a novel treatment for managing pain for cancer patients, the intrathecal drug delivery system (IDDS).
It is a method of managing severe pain experienced by the unfortunate patients. As an interventional pain management therapy, the intrathecal drug delivery is designed to manage chronic pain by delivering pain medication directly to the intrathecal space. While hailing this treatment as a boon to the ailing cancer patients, he said this pain management technique has the potential to provide improved pain control with decreased side effects, Dr Ramnarayan told Pharmabiz.
He said acknowledging the gravity of the cancer related pain, world medical fraternity has formulated several new pain relief guidelines to manage this kind of distress, especially for the terminally ill. The method of intrathecal drug delivery system has a significance of that kind.
He said, according to WHO data, only three percent of the total cancer patients in India are able to get the comfortabilities of pain management therapies.
Explaining the conventional method of treatment to cancer, the doctor said, 75 to 85 per cent of patients with cancer pain can be dealt well with oral morphine, which often remains the mainstay for cancer pain management. However, he added that when the pain relief was found inadequate with oral morphine or the patient was getting intolerable side effects owing to high doses of oral medication, then the only available alternative option would be the interventional therapies like IDDS.
"When patients get excessive side effects with oral morphine it is reasonable to directly target the spinal cord (which has morphine receptors) that carries pain signals to the brain where the feeling of pain is experienced by the patient's body. Accordingly, neurosurgeons, pain specialists, and orthopaedic surgeons are increasingly suggesting that intrathecal drug delivery has proven effect on many appropriately selected and screened patients," he said.
About the technicality of the treatment, the neurosurgeon said the intrathecal drug delivery system of pain treatment uses an implantable pump and catheter that are surgically placed under the skin of the abdomen to deliver medication directly to the intrathecal space (the fluid-filled area surrounding the spinal cord). This is a technique which is used to deliver the pain killer directly in the spinal cord (intrathecal space) thereby decreasing the dose 300 times there by reducing the side-effects comparatively. The medication binds to receptors in the spinal cord to blocks pain signals travelling up the spinal cord before they reach the brain, providing pain relief for the patient.
To a query, he said many doctors still do not consider pain management as an integral part of cancer treatment. He hoped that the adoption of intrathecal therapy by oncologists and palliative care physicians would broaden their ability to control pain and limit medication side effects. The goals of this therapy are to preserve the patient's quality of life, function and independence, regardless of prognosis. According to him, the availability of this therapy as a management option for uncontrolled pain or intolerable side effects offers significant reassurance to cancer patients.