{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T11:36:03Z","timestamp":1791459363689,"version":"4.3.4"},"reference-count":32,"publisher":"Walter de Gruyter GmbH","issue":"4","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic cancer pain, especially in advanced stages, remains a significant clinical challenge, often necessitating complex multimodal strategies. Although systemic opioids are standard therapy, many patients experience inadequate relief or adverse effects. Implantable intrathecal drug delivery systems (IDDS) have emerged as a promising alternative, enabling targeted analgesia with reduced opioid burden and improved quality of life. This narrative review summarizes current evidence on the clinical application, efficacy, safety, and cost-effectiveness of IDDS in cancer pain management. Literature sources include clinical trials, observational studies, health-economic evaluations, and international guidelines published between 2002 and 2023. A Slovenian case report is included, detailing the first national experience with IDDS implantation for refractory cancer pain. Clinical outcomes were assessed using the Visual Analogue Scale (VAS), European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and the revised Edmonton Symptom Assessment System (r-ESAS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Findings from the literature confirm that intrathecal pumps provide substantial and sustained pain relief, often with a significant reduction in systemic opioid doses and associated side effects. Compared to conventional pharmacotherapy, intrathecal delivery is associated with improved patient-reported outcomes, fewer hospitalizations, and lower long-term healthcare costs. In the Slovenian case, VAS scores decreased from &gt; 8 to 3 shortly after implantation, with parallel improvements in quality-of-life indices. IDDS represent a clinically effective and economically sustainable option for selected patients with complex cancer pain, particularly when systemic therapy proves insufficient. Their integration into multidisciplinary palliative care pathways supports personalized, safe, and compassionate treatment approaches. By combining an evidence-based overview with real-world national experience, this review underscores the therapeutic value of intrathecal drug delivery and calls for broader clinical awareness and future research.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2478\/raon-2025-0060","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T16:58:44Z","timestamp":1765904324000},"page":"477-487","source":"Crossref","is-referenced-by-count":3,"title":["Breaking the pain barrier: implantable intrathecal pump therapy as a game-changer in cancer pain management"],"prefix":"10.2478","volume":"59","author":[{"given":"Iztok","family":"Potocnik","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Intensive Care and Pain Therapy, Institute of Oncology Ljubljana , Ljubljana , Slovenia"},{"name":"Department of Anesthesiology and Reanimatology, Faculty of Medicine, University of Ljubljana , Ljubljana , Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Branka","family":"Strazisar","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care and Pain Therapy, Institute of Oncology Ljubljana , Ljubljana , Slovenia"},{"name":"Department of Anesthesiology and Reanimatology, Faculty of Medicine, University of Ljubljana , Ljubljana , Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Lenasi","sequence":"additional","affiliation":[{"name":"Institute of Physiology, Faculty of Medicine, University of Ljubljana , Ljubljana , Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teodora","family":"Zupanc","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care and Pain Therapy, Institute of Oncology Ljubljana , Ljubljana , Slovenia"},{"name":"Department of Anesthesiology and Reanimatology, Faculty of Medicine, University of Ljubljana , Ljubljana , Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2025,12,16]]},"reference":[{"key":"2026071215564923044_j_raon-2025-0060_ref_001","doi-asserted-by":"crossref","unstructured":"Zhang H. Cancer pain management-new therapies. Curr Oncol Rep 2022; 24: 223-6. doi: 10.1007\/s11912-021-01166-z","DOI":"10.1007\/s11912-021-01166-z"},{"key":"2026071215564923044_j_raon-2025-0060_ref_002","doi-asserted-by":"crossref","unstructured":"Bandara S, Bicket MC, McGinty EE. Trends in opioid and non-opioid treatment for chronic non-cancer pain and cancer pain among privately insured adults in the United States, 2012-2019. PLoS ONE 2022; 17: e0272142. doi: 10.1371\/journal.pone.0272142","DOI":"10.1371\/journal.pone.0272142"},{"key":"2026071215564923044_j_raon-2025-0060_ref_003","doi-asserted-by":"crossref","unstructured":"Daud ML, Simone GG. Management of pain in cancer patients - an update. Ecancermedicalscience 2024; 18: 1821. doi: 10.3332\/ecancer.2024.1821","DOI":"10.3332\/ecancer.2024.1821"},{"key":"2026071215564923044_j_raon-2025-0060_ref_004","doi-asserted-by":"crossref","unstructured":"Bhatia G, Lau ME, Koury KM, Gulur P. Intrathecal Drug Delivery (ITDD) systems for cancer pain. F1000Res 2013; 2: 96. doi: 10.12688\/f1000research.2-96.v4","DOI":"10.12688\/f1000research.2-96.v1"},{"key":"2026071215564923044_j_raon-2025-0060_ref_005","doi-asserted-by":"crossref","unstructured":"Gilmer-Hill HS, Boggan JE, Smith KA, Wagner FC Jr. Intrathecal morphine delivered via subcutaneous pump for intractable cancer pain: a review of the literature. Surg Neurol 1999; 51: 12-5. doi: 10.1016\/s0090-3019(98)00080-9","DOI":"10.1016\/S0090-3019(98)00080-9"},{"key":"2026071215564923044_j_raon-2025-0060_ref_006","unstructured":"Dupoiron D, Duarte R, Carvajal G, Aubrun F, Eldabe S. Rationale and recent advances in targeted drug delivery for cancer pain: Is it time to change the paradigm? Pain Physician 2022; 25: E414-E425"},{"key":"2026071215564923044_j_raon-2025-0060_ref_007","doi-asserted-by":"crossref","unstructured":"Goel V, Kaizer A, Darrow D, Rosielle D, Owens B, Blaes A. 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