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Long-Term Spinal Opioid Therapy in Terminally Ill Cancer Pain Patients

Department of Anesthesiology, Academic Hospital "Vrije Universiteit," Amsterdam, The Netherlands

Correspondence: Michel F.M. Wagemans, M.D., Department of Anesthesiology, Academic Hospital "Vrije Universiteit," P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. Telephone: 31-20-444-4386; Fax: 31-20-444-4385.

In terminally ill cancer patients with refractory pain, long-term spinal opioid therapy may provide a profound analgesia with minimal side effects. The reversibility of the technique and its efficacy throughout the body and for different types of pain are important advantages. For epidural administration, it is preferable to use lipid soluble opioids (sufentanil). For intrathecal administration, morphine is the best choice. The advantages of intrathecal administration over epidural administration are the need for lower doses because of a more direct administration at the receptor site, the easy positioning of the catheter, and less risk for migration of the catheter. In severe refractory pain which does not respond to spinal opioids, the use of non-opioids (e.g., a local anesthetic or an alpha-2 adrenoreceptor agonist) as coanalgesics may be recommended for improving pain relief. Long-term spinal opioid therapy at home has been made possible by technical and organizational development. In home care, only one physician should be the manager for the patient. Coordination should be optimized among patient, family, general practitioner, oncologist, anesthesiologist, home nurse, technician, and pharmacist.

Key Words. Analgesics: morphine, opioids • Anesthetic techniques: catheter, epidural, intrathecal, spinal • Pain: cancer