Ballantyne, J.C., & Carwood, C.M. (2005). Comparative efficacy of epidural, subarachnoid, and intracerebroventricular opioids in patients with pain due to cancer. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD005178.

To compare intracerebroventricular (ICV) opioid therapy with either subarachnoid (SA) or epidural (EPI) opioid therapy

DATABASES: AgeLine (1978–1991), Bioethics (1973–1994), BIOSIS (1969–1991), Catline (through 1991), Dissertation Abstract (1966–1991), EMBASE (1974–1991), ERIC (1966–1991), FEDRIP (1966–1991), GPO (1976–1991), Health (1975–1991), NTIS (1964–1991), Psychological Abstracts (1967–1991), Religion Index (1975–2001), Sociological Abstracts (1963), Social Science Research (1972), MEDLINE (1966–2003), CINAHL (1982–2003), and CANCERLIT (1975–2002)

COMMENTS ON LITERATURE USED: Data were extracted from trials and used to compare analgesic efficacy, pharmacologic adverse effects, and catheter and system problems. No controlled trials were identified for these treatments. Data extracted looked at the best available evidence to evaluate the use of these treatments in patients with cancer.

FINAL NUMBER STUDIES INCLUDED: ICV = 13 trials (337 patients); EPI = 31 trials (1,343 patients); SA = 28 trials (722 patients)

TRIALS EVALUATED: No controlled trials were identified for these treatments.

Uncontrolled studies show that neuraxial opioid therapy often is effective for treating cancer pain that has not been controlled by systemic treatment. Long-term use of neuraxial therapy can be complicated by problems with catheters. Some of the therapies are costly. ICV therapy is more costly; however, comparative efficacy, side effects, and system longevity are unknown.

More rigorous reporting of efficacy and complications needs to be done before ICV can be recommended as a first-line therapy.