title: High-dose epidural infusion of opioids for cancer pain: cost issues.
abstract: The safety and efficacy of intraspinal opioids as therapy for selected patients with cancer pain are well-established. The choice of the appropriate drug is influenced by many variables that are to date incompletely elucidated. The cost of therapy is an increasingly important component of decision-making. This report describes the management of a patient who achieved excellent pain control with the administration of epidural sufentanil and bupivacaine. Daily Average Wholesale Price for sufentanil was, however, $698. Until the data comparing the efficacy of different epidurally administered opioids in the treatment of cancer pain are available, we suggest that treatment with more costly opioids be reserved for patients for whom analgesia cannot be achieved after maximizing epidural morphine analgesia with aggressive side-effect management.
authors.affiliation: Department of Neuro-Oncology, University of Texas, M. D. Anderson Cancer Center, Houston 77030, USA.
authors.forename: P L
authors.initials: PL
authors.lastname: Manfredi
authors.forename: S W
authors.initials: SW
authors.lastname: Chandler
authors.forename: R
authors.initials: R
authors.lastname: Patt
authors.forename: R
authors.initials: R
authors.lastname: Payne
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000701:Analgesics, Opioid