[Long-term epidural administration of opiates]

Area of Science:

• Pain Management
• Neuropharmacology
• Oncology

Context:

• Chronic spinal opiate administration is a long-standing clinical practice for cancer pain.
• The safety and rationale for spinal opiates are well-established.
• Lack of controlled studies has led to unclear indications for spinal opiate therapy.

Purpose:

• To review the established safety and rationale for spinal opiate administration.
• To discuss the unclear indications for spinal opiate therapy despite patient benefits.
• To address technological, financial, and home care management issues associated with spinal opiate use.

Summary:

• Spinal administration of morphine and other opiates is effective for cancer pain patients who do not respond to oral treatments.
• While the safety of chronic spinal opiate administration is established, controlled studies demonstrating its advantages are lacking.
• Patients unable to achieve adequate pain relief with oral opiates can significantly benefit from switching to the spinal route.

Impact:

• Highlights the need for controlled studies to clarify indications for spinal opiate therapy.
• Addresses practical challenges including technological, financial, and home care management for spinal opiate treatments.
• Emphasizes the multidisciplinary approach involving home physicians, nursing teams, and pain management specialists for optimal patient care.