The use of intrathecal drug delivery systems (IDDS) in the management of intractable cancer pain has increased. However, catheter obstruction as a complication of IDDS can be fatal, and epidural metastasis is a relatively common complication in patients with advanced cancer. Herein, we present a case of catheter obstruction due to epidural metastasis after IDDS implantation in a patient with advanced gastric cancer. Because of IDDS failure, intravenous morphine administration was started, and thoracic epidural block was performed, which relieved the pain. The patient was discharged to a hospice on maintenance with oral and intravenous pain medications. In conclusion, preoperative magnetic resonance imaging should be conducted before IDDS implantation to assess spinal metastasis in patients with cancer. Moreover, the expected clinical course and life expectancy of the patient should be considered in patients at risk for spinal metastasis.

Keywordscancer pain, neoplasm metastasis, drug delivery systems, implantable infusion pumps