The inappropriate use of the epidural route in cancer pain

There continues to be controversy concerning the optimal use of the epidural route in cancer pain. Although spinal opioids undoubtedly give long-lasting analgesia with low doses, indiscriminate use cannot be recommended. Inappropriate indications for the epidural route are reported in three patients who required home palliative care. In contrast to epidural treatment, which caused severe clinical problems, simpler measures, including oral and subcutaneous opioids, were able to give adequate analgesia and a better quality of life. Education of nursing staff and family is necessary when using opioid epidural analgesia at home. Wide dissemination of World Health Organization (WHO) guidelines among doctors and health-care workers can avoid the use of unnecessary and complicated techniques and improve the treatment of terminally ill patients suffering from cancer pain.