ArticleJournal of pain research2025
The Addition of Intrathecal Clonidine to Reduce Medication-Related Side-Effects in Cancer Pain: A Retrospective Cohort Study.
Article in Journal of pain research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
3 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Spinal analgesia in cancer pain management-MASCC general practice recommendations.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025Guideline
- Intrathecal Drug Delivery Systems for Chronic Pain Management: A Narrative Review of Pharmacologic Agents, Clinical Applications, and Considerations.Pharmacy (Basel, Switzerland) · 2025Review
- Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
Abstract
Objective: Compared to conventional medical management, targeted drug delivery provides superior cancer pain management with fewer side-effects and potentially improved survival. Intrathecal (IT) clonidine has been used off-label to improve analgesia in patients with cancer pain, but evidence regarding safe dosing in this patient population is limited. This study evaluates the impact of adding IT clonidine on pain, opioid consumption, and the prevalence of medication-related side-effects. It also provides initial dosing recommendations for cancer pain. Materials and Methods: This was a retrospective chart review conducted at a single academic cancer center. Medical records between 2012 and 2022 were queried for patients who had an intrathecal pump (ITP). Patients' charts were reviewed prior to starting IT clonidine, at the IT clonidine start date, at 1-3 months follow-up, and at over three months follow-up. Primary outcomes included the visual analog scale (VAS) score and daily systemic morphine milligram equivalents (MME). Secondary outcomes included IT or systemic medication side-effects and the daily doses of concurrent IT opioids and local anesthetic (LA). Results: Eighteen patients were included. No significant change in VAS or systemic MME was observed at follow-up after starting IT clonidine. Median daily IT bupivacaine and opioids with or without patient-controlled boluses significantly rose by the first follow-up; by the second follow-up, only IT opioids were elevated. There was a trend towards a lower prevalence of medication-related side-effects across follow-up periods. On post-hoc logistic regression analysis, IT clonidine dosing was the sole significant predictor of side-effect prevalence. Higher IT clonidine dosing was associated with a lower likelihood of side-effects. Initial IT clonidine doses of 40-60 mcg/day were associated with a 50-75% reduced probability of side-effects. Conclusion: While its role in reducing pain and systemic opioids is complex, IT clonidine may have a beneficial role in mitigating medication-related side-effects from systemic opioids, IT opioids, or LA for cancer pain. IT clonidine may be safely initiated at doses of 40-60 mcg/day for this indication.
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