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The following is a summary of “Addition of Intrathecal Clonidine to Reduce Medication-Related Side-Effects in Cancer Pain: A Retrospective Cohort Study,” published in the March 2025 issue of Journal of Pain Research by Bulat et al.
Researchers conducted a retrospective study to evaluate the effects of intrathecal (IT) clonidine on pain, opioid use, and medication-related side effects in individuals with cancer pain while also providing initial dosing recommendations.
They analyzed medical records from 2012 to 2022 for individuals with an intrathecal pump (ITP). Data were reviewed before initiating IT clonidine at the start date, at 1–3 months, and beyond 3 months. Primary outcomes included changes in the visual analog scale (VAS) score and daily systemic morphine milligram equivalents (MME). Secondary outcomes involved IT or systemic medication side effects and daily doses of concurrent IT opioids and local anesthetics (LA).
The results showed that 18 individuals were included in the analysis. No significant changes in the VAS score or systemic MME were observed after starting IT clonidine. Median daily IT bupivacaine and opioids, with or without patient-controlled boluses, significantly increased at the first follow-up, while only IT opioids remained elevated at the second follow-up. A trend toward a lower prevalence of medication-related side effects was noted over time. Post-hoc logistic regression analysis identified IT clonidine dosing as the only significant predictor of side-effect prevalence. Higher IT clonidine doses were linked to a lower likelihood of side effects, with initial doses of 40–60 mcg/day associated with a 50–75% reduced probability of side effects.
Investigators concluded that IT clonidine, initiated at 40-60 mcg/day, might help reduce medication-related side effects from systemic or IT opioids and local anesthetics in cancer pain management, although its role in direct pain reduction is complex.
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