脊髓镇痛常被认为是对系统性阿片类药物反应不佳患者的一种有效策略。尽管文献报道使用腰椎内给药系统（IDDS）治疗癌症疼痛的数据令人乐观，但批判性分析显示其效益有限。实际上，腰椎内治疗可能是在极有选择性的人群中使用的有效手段。然而，在综合性姑息治疗的总体视角下，通过结合腰椎治疗、阿片类药物和其他药物的使用，可能有助于治疗临床预后不良的癌症疼痛患者，根据埃德蒙顿分期系统。本文描述了经历了不同治疗方法的患者的长期管理情况，包括多个阿片类药物线、腰椎内镇痛和综合性姑息治疗。该病例报告描述了癌症疼痛的管理可能是复杂的，需要在使用阿片类药物、换算比率、不同途径（尤其是腰椎内给药）以及提供综合性姑息治疗方面具有高水平的专业知识。对于这种极端情况，没有基于证据的治疗可供考虑，只有经验和知识才能指导在大约六个月的时间内进行有效的治疗。针对疾病进程中的每一种具有挑战性的临床情况，均需要及时的治疗策略。版权所有©2023 Elsevier Inc.发布。

Spinal analgesia is often claimed as an effective strategy for patients with a poor response to systemic opioids. Despite the optimistic data reported in literature with intrathecal drug delivery systems (IDDS) for cancer pain, a critical analysis showed modest benefit. Indeed, intrathecal therapy may be potent means to be used in a very selected population. However, ability to manage spinal therapy combined with the use of opioids and other drugs in the general perspective of a comprehensive palliative care treatment may allow to resolve refractory cancer pain in a patient with a clinical profile of poor pain prognosis, according to the Edmonton staging system.A long-term management of patient who underwent different therapeuthic approaches, including multiple opioid lines, intrathecal analgesia, and a comprehensive palliative care treatment, is described.The case reported describes how the management of cancer pain may be complex, requiring a high level of expertise on using opioids, conversion ratios, different routes, particularly the intrathecal one, as well as providing a comprehensive palliative care treatment.No evidence-based treatment can be taken into consideration for such extreme conditions, where only experience and knowledge can guide to an effective course of treament along a period of about six months. Timely therapeutic strategies are needed to be performed in each challenging clinical situation along the course of disease.Copyright © 2023. Published by Elsevier Inc.