• Best Pract Res Clin Anaesthesiol · Dec 2002

    Review

    Epidural and intrathecal analgesia for cancer pain.

    • Divakara Kedlaya, Lowell Reynolds, and Steven Waldman.
    • Center For Pain Management, Loma Linda University, Loma Linda, California 92354, USA.
    • Best Pract Res Clin Anaesthesiol. 2002 Dec 1; 16 (4): 651-65.

    AbstractThe three-step analgesic ladder approach developed by the World Health Organization works well in treating the vast majority (70-90%) of patients suffering from pain related to cancer. In those patients who do not get pain relief by this three-step approach, intraspinal agents can be a fourth step in managing pain of malignant origin. Although morphine is the only opioid approved by the US Food and Drug Administration for intraspinal use, many different opioid analgesics are used intraspinally, including hydromorphone, fentanyl, sufentanil, meperidine and methadone in the treatment of cancer pain. Many non-opioid agents have also been used intraspinally either alone or in combination with opioids in the treatment of intractable cancer pain. This chapter summarizes the clinical use of these agents with some practical points.

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