High-tech pain management utilizing multiple analgesics--a case study

Intraspinal delivery of opioids is a proven method of pain management therapy for severe cancer pain. Effective analgesia can be achieved with spinal opioid infusions while minimizing central side effects such as sedation, nausea, and severe constipation. Indications for intraspinal opioids include unmanageable side effects with increasing doses of oral or parenteral opioids or little or no pain relief with increasing dosages of strong opioids. The purpose of this case study is to illustrate the multidisciplinary approach required and multiple analgesics needed to effectively assess and manage a challenging pain management situation. This patient required the administration of intraspinal morphine, intravenous hydromorphone, and intravenous midazolam in order to effectively manage his pain. The use of spinal analgesia and multiple analgesics offers challenges to oncology and hospice nurses but is an effective modality for otherwise intractable cancer pain.