Epidural opiates: long-term experiences in cancer pain.

Epidural opiates were administered to 139 patients with pain due to malignant diseases via a chronic indwelling catheter inserted percutaneously. So far, 9,716 days of treatment can be evaluated. In 87% of the patients whose pain previously could not be controlled with conventional analgesic approaches, epidural opiates resulted in remarkable pain relief. With a mean daily dose of 15.6 mg morphine (range 2–290 mg) or 0.86 mg buprenorphine (range 0.15–7.2 mg) half of the patients could be treated as outpatients. The mean duration of therapy was 72 days (range 1–700 days), 26 catheters being in place for more than 100 days and one catheter being in place for 501 days. Two severe side-effects (meningitis) were observed, both patients being free of symptoms after catheter removal and antibiotic therapy. Epidural opiates proved to be a valuable method of pain control in terminal illness. The method should be reserved for those patients, for whom oral opiates fail to produce effective pain relief.