{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T16:07:50Z","timestamp":1788883670952,"version":"build-2803163510"},"reference-count":16,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2026,8,13]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cancer-related pain is common and difficult to manage, and many patients require opioid therapy with dose-limiting toxicity. As pain progresses, opioid escalation may result in adverse effects and suboptimal analgesia. Intrathecal drug delivery (IDD) provides targeted analgesia and may reduce systemic toxicity. This study evaluated temporal trends in pain and symptom burden before and after IDD initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective analysis of longitudinal Brief Pain Inventory (BPI) and Condensed Memorial Symptom Assessment Scale (CMSAS) scores in 435 patients with cancer pain treated with IDD at an academic cancer center between 2013 and 2023. Inclusion required \u22651 symptom assessment within 30 days prior to implantation and survival &gt;10\u2009days postimplant. Primary outcomes were changes in BPI-Severity (BPI-SEV), BPI-Interference (BPI-INT) and CMSAS-Physical (CMSAS-PHYS) after IDD, estimated using joint longitudinal\u2013survival models to account for informative dropout due to death over 1 year. Pre-IDD symptom trajectories were modeled separately. Secondary outcomes included remaining BPI and CMSAS domains assessed at prespecified time points up to 1 year, analyzed descriptively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>222 patients met inclusion criteria. During follow-up, 91% discontinued systemic opioids. In joint models over the first 90 days after implantation, BPI-SEV decreased by 0.014 units\/day (n=219; 95%\u2009CI \u22120.020 to \u22120.009; p&lt;0.001), BPI-INT decreased by 0.020 units\/day (n=209; 95%\u2009CI \u22120.029 to \u22120.011; p&lt;0.001) and CMSAS-PHYS improved by 0.004 units per day (n=195; 95%\u2009CI \u22120.006 to \u22120.001; p=0.002). Symptom trajectories worsened prior to implantation and improved following IDD initiation. Mean composite scores improved significantly across all time points for BPI-SEV, BPI-INT and CMSAS-PHYS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among patients with advanced cancer, pain and symptom burden worsened prior to IDD but improved within 90 days after implantation, with sustained benefits observed up to 1 year.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2026-107984","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T15:23:17Z","timestamp":1788880997000},"page":"1055-1064","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Pain and symptom severity outcomes in patients with cancer before and after intrathecal drug delivery: mixed model analysis in 222 cases"],"prefix":"10.1136","volume":"51","author":[{"given":"Daniel W","family":"Odell","sequence":"first","affiliation":[{"name":"University of Utah Health, Huntsman Cancer Institute, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill E","family":"Sindt","sequence":"additional","affiliation":[{"name":"University of Utah Health, Huntsman Cancer Institute, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"McNeal","sequence":"additional","affiliation":[{"name":"University of Utah Health, Huntsman Cancer Institute, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7483-6447","authenticated-orcid":false,"given":"Kristen Michelle","family":"Saad","sequence":"additional","affiliation":[{"name":"University of Utah Health, Huntsman Cancer Institute, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela P","family":"Presson","sequence":"additional","affiliation":[{"name":"Internal Medicine-Epidemiology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Internal Medicine-Epidemiology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3744-1742","authenticated-orcid":false,"given":"Shane E","family":"Brogan","sequence":"additional","affiliation":[{"name":"University of Utah Health, Huntsman Cancer Institute, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"2026090808101539000_51.9.1055.1","doi-asserted-by":"crossref","DOI":"10.3390\/cancers15030591","article-title":"Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis","volume":"15","author":"Snijders","year":"2023","journal-title":"Cancers (Basel)"},{"key":"2026090808101539000_51.9.1055.2","unstructured":"WHO . Guidelines for the pharmacological treatment of persisting pain in adults and adolescents. Geneva, 2018."},{"key":"2026090808101539000_51.9.1055.3","doi-asserted-by":"crossref","DOI":"10.1093\/jncics\/pkae012","article-title":"Opioid use in cancer patients compared with noncancer pain patients in a veteran population","volume":"8","author":"Mudumbai","year":"2024","journal-title":"JNCI Cancer Spectr"},{"key":"2026090808101539000_51.9.1055.4","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1001\/jamaoncol.2019.1439","article-title":"Prevalence of Chronic Pain and High-Impact Chronic Pain in Cancer Survivors in the United States","volume":"5","author":"Jiang","year":"2019","journal-title":"JAMA Oncol"},{"key":"2026090808101539000_51.9.1055.5","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2002.02.118"},{"key":"2026090808101539000_51.9.1055.6","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1213\/ANE.0000000000004276","article-title":"Prospective Association of Serum Opioid Levels and Clinical Outcomes in Patients With Cancer Pain Treated With Intrathecal Opioid Therapy","volume":"130","author":"Brogan","year":"2020","journal-title":"Anesth Analg"},{"key":"2026090808101539000_51.9.1055.7","doi-asserted-by":"crossref","DOI":"10.6004\/jnccn.2025.0032","article-title":"Adult Cancer Pain, Version 2.2025, NCCN Clinical Practice Guidelines In Oncology","volume":"23","author":"Swarm","year":"2025","journal-title":"J Natl Compr Canc Netw"},{"key":"2026090808101539000_51.9.1055.8","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1016\/j.neurom.2024.08.006","article-title":"The Polyanalgesic Consensus Conference (PACC)\u00ae: Updates on Clinical Pharmacology and Comorbidity Management in Intrathecal Drug Delivery for Cancer Pain","volume":"28","author":"Deer","year":"2025","journal-title":"Neuromodulation"},{"key":"2026090808101539000_51.9.1055.9","doi-asserted-by":"publisher","DOI":"10.2147\/JPR.S315585"},{"key":"2026090808101539000_51.9.1055.10","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1111\/ner.13175","article-title":"Initiation of Intrathecal Drug Delivery Dramatically Reduces Systemic Opioid Use in Patients With Advanced Cancer","volume":"23","author":"Sindt","year":"2020","journal-title":"Neuromodulation"},{"key":"2026090808101539000_51.9.1055.11","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1111\/ner.13517","article-title":"Initial Intrathecal Dose Titration and Predictors of Early Dose Escalation in Patients With Cancer Using a 100:1 Oral to Intrathecal Morphine Conversion Ratio","volume":"24","author":"Sindt","year":"2021","journal-title":"Neuromodulation"},{"key":"2026090808101539000_51.9.1055.12","doi-asserted-by":"crossref","unstructured":"Bruera E , Portenoy RK . Cancer Pain: Assessment and Management. Cambridge, UK\u202f; New York, N.Y: Cambridge University Press, 2003:xiii\u2013485.","DOI":"10.1017\/CBO9780511550096"},{"key":"2026090808101539000_51.9.1055.13","doi-asserted-by":"publisher","DOI":"10.1081\/CNV-200026487"},{"key":"2026090808101539000_51.9.1055.14","unstructured":"Centers for Medicare and Medicaid Services . Opioid oral morphine milligram equivalent (MME) conversion factors. 2018. Available: https:\/\/www.cms.gov\/Medicare\/Prescription-Drug-Coverage\/PrescriptionDrugCovContra\/Downloads\/Oral-MME-CFs-vFeb-2018.pdf"},{"key":"2026090808101539000_51.9.1055.15","doi-asserted-by":"crossref","unstructured":"Rizopoulos D , Papageorgiou G . JMbayes2: extended joint models for longitudinal and time-to-event data_.doi:10.32614\/cran.package.jmbayes2. 2025.","DOI":"10.32614\/CRAN.package.JMbayes2"},{"key":"2026090808101539000_51.9.1055.16","unstructured":"Team, R.C . R: a language and environment for statistical computing_. r foundation for statistical computing. Vienna, Austria, Available: https:\/\/www.R-project.org\/"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2026-107984","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T15:25:30Z","timestamp":1788881130000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2026-107984"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":16,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,8]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/rapm-2026-107984"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2026-107984","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}