title: Challenges associated with spinal opioid therapy for pain in patients with advanced cancer: a report of three cases.
abstract: Intraspinal opioid therapy has been increasingly used for the management of cancer pain refractory to traditional treatment. However, this approach may present challenges in patients with advanced cancer. Three cases are presented that highlight the challenges associated with using neuraxial analgesia to manage cancer pain that was felt to be "refractory" to conventional treatment. Before an invasive procedure, such as placement of a permanent intrathecal opioid delivery system, a rigorous assessment and treatment of total pain (physical, psychological, spiritual, social, and practical) by an interdisciplinary team would be prudent.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030, USA. syennu@mdanderson.org
authors.forename: Sriram
authors.initials: S
authors.lastname: Yennurajalingam
authors.forename: Rony
authors.initials: R
authors.lastname: Dev
authors.forename: Paul W
authors.initials: PW
authors.lastname: Walker
authors.forename: Suresh K
authors.initials: SK
authors.lastname: Reddy
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects*; D002277:Carcinoma / Q000150:complications; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications; D010146:Pain / Q000150:complications / Q000188:drug therapy*; D010147:Pain Measurement; D010166:Palliative Care; D011471:Prostatic Neoplasms / Q000150:complications; D012720:Severity of Illness Index
chemical_list: D000701:Analgesics, Opioid