Sequential flex mode for intrathecal infusion after continuous mode failure: a retrospective follow-up study for refractory cancer pain management
Authors' conclusion
The sequential flex intrathecal infusion mode may provide better pain relief when the continuous mode loses efficacy, as well as help to reduce daily dosage escalation.
Study context
- Population
- Patients with refractory cancer pain on intrathecal drug delivery systems (IDDS) suffering despite a high continuous flow rate and a high daily drug dosage59 switches
- Participants
- 53 patients
- Exposure
- Sequential flex mode vs Continuous flow rate mode
- Outcome
- Better pain relief with the sequential flex mode than the continuous flow rate mode
Methodological detailsmonocentric
- Monocentric
Main finding
As reported in the abstract
≥30% NRS pain reduction with sequential flex mode
Sequential flex mode
71.7%
± 6.43%
Observational data: associations, not effects.
Further findings
≥50% Numerical Rating Scale (NRS) pain reduction (per switch)
- Switches with pain relief >50% NRS reduction on sequential flex mode
- 52.5%±7.12%
Median NRS before vs after switch
- Significant pain reduction after the switch, NRS from 6.4 (SD 2.0) to 3.3 (SD 2.2)
- P < 0.0001
Intrathecal morphine and ropivacaine daily doses (switch success)
- Remained stable around the switch
Safety
Adverse effects (per switch)
- Adverse effects in 12 of 59 switches
- 20.3%±6.06%
- Non-serious; most commonly increased anxiety
Original publication
Sequential flex mode for intrathecal infusion after continuous mode failure: a retrospective follow-up study for refractory cancer pain management. Reg Anesth Pain Med. Published 8 September 2026. doi:10.
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