Introduction: The British Pain Society guidelines (1) for management of intrathecal therapy set out broad recommendations but there are no specific details about management of intrathecal therapy. The purpose of this survey was to identify variations in practice in the use of intrathecal/epidural therapy for cancer pain.Methods: An internet based survey was sent to pain clinicians. Questions were asked pertaining to the equipment, drugs, and processes used.Results: Eighteen respondents completed the survey, all of whom were pain management consultants. A majority (56%) do not use external devices to infuse drugs. Most respondents who use them are comfortable using this therapy in hospital, hospice, and domiciliary settings, and a smaller proportion in outpatient settings (33%). All respondents feel that the catheters should not be left in situ for more than six months. The majority (56%) felt that 1-3 months is acceptable, 22% for 3-6 months and 22 % for 2-4 weeks.Drugs are usually prepared by a pharmacy, but 30% prepare the drugs themselves. There is no consensus on how frequently the medications should be changed. The medications are changed by either the doctor or specialist nurse and are generally checked by two personnel. However, in 29% of responses, only one person checks the infusion bag against the prescription.Discussion: A recent review showed that external intrathecal catheters are safe, cheap, and effective in both hospitalized and home bound cancer patients (2). There is still reluctance to use them, perhaps due to concerns of infection. Infection is a potentially serious risk with catheters, but there is no consensus on the acceptable duration for which they can be left in situ. The BPS guidelines emphasize that all efforts must be made to prevent complications (1). Deaths have been reported with intrathecal therapy in non-cancer pain that may be due to practitioner error (3). Preparing medications without involving pharmacy and failure to check ag...
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