Epidural Opiates for the Treatment of Cancer Pain

Epidural opiate analgesia represent an alternative to the systemic application of opiates in the treatment of chronic pain. The efficacy of this new method — particularly in the therapy of cancer pain — has been demonstrated by a great number of clinicians (Poletti et al. 1981; Christensen 1982; Howard et al. 1981; Zenz et al. 1981a; Magora et al. 1980; Chayen et al. 1980). Even in cases of unsuccessful treatment with high doses of opiates parenterally given, analgesia can be achieved with significantly lower doses of opiates by epidural administration (Coombs et al. 1981; Howard et al. 1981; Poletti et al. 1981). Nevertheless, epidural opiates are not ideal in every case of cancer pain treatment. A catheter must be inserted and checked regularly and, moreover, the epidurally injected opiate can induce severe side effects, among which are life-threatening side effects such as respiratory depression (Gustafsson et al. 1982). Epidural opiates do not help in every case of pain and they cannot be used in every localization of pain. Therefore, guidelines are required for the safe use of epidural opiates in patients suffering from cancer pain.