Premagovanje bolečine: zdravljenje z implantabilno intratekalno črpalko je prelomnica za obvladovanje bolečine pri bolnikih z rakom
Bibliographic record
Abstract
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). 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 >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
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".