Skip to main content

Advertisement

SpringerLink
Log in

Epidural techniques for cancer pain management: When, why, and how?

  • Published:
Current Review of Pain Aims and scope Submit manuscript

Abstract

Epidural analgesia is an important tool in the management of intractable cancer pain. Fundamental questions surrounding the use of epidural catheters in cancer pain management include: When is epidural analgesia appropriate?, Why is epidural analgesia beneficial?, and How does the clinician implement and manage epidural catheters in patients with cancer pain? This clinical review addresses these questions through a discussion of patient selection criteria, the advantages and disadvantages of the epidural route, the concept of functional analgesia, cost issues, device selection, treatment planning, and complications. The author concludes that achieving an optimal outcome with epidural techniques in a patient with cancer involves a negotiation between patient and provider.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Enneking KF, Benzon HT: Oral anticoagulants and regional anesthesia: a perspective. Reg Anesth 1998, 23(suppl):140- 145. This paper was published from a consensus meeting organized and sponsored by the American Society of Regional Anesthesia. It gives the practitioner guidelines for determining when regional anesthesia techniques may be used in patients who are receiving anticoagulation.

    CAS  Google Scholar 

  2. Larsen MM, Chandler SW, Payne R, Huber SL: Cost of unscheduled inpatient admissions for pain in a cancer hospital [abstract]. In Abstracts of the Eighth World Congress on Pain. Seattle: IASP Press; 1996:205.

    Google Scholar 

  3. Ferrell B: Cost issues surrounding the treatment of cancer related pain. J Pharm Care Pain Symptom Control 1993, 1:9–23.

    Google Scholar 

  4. Torma T: Malignant tumors of the spine and the spinal extradural space: a study based on 250 histologically verified cases. Acta Chir Scand 1987, 255(suppl):1–138.

    Google Scholar 

  5. Zenz M, Schappler-Scheele B, Neuhans R, et al.: Long-term peridural morphine analgesia in cancer pain. Lancet 1981, 1:91.

    Article  CAS  PubMed  Google Scholar 

  6. Eisenach J, De Kock M, Klimscha W: Alpha-2 adrenergic agonists for regional anesthesia: a clinical review of clonidine (1984-1995). Anesthesiology 1996, 85:655–674. This very well-written review covers the history, development, pharmacology, and clinical studies of epidural and intrathecal clonidine. Its reference list gives a worldwide clinical perspective on the use of clonidine. The pharmacology and physiology of heart rate and blood pressure changes during the use of neuraxial clonidine are very well covered in terms that are easily understood.

    Article  CAS  PubMed  Google Scholar 

  7. Cousins MJ, Plummer JL: Spinal opioids in acute and chronic pain. In Advances in Pain Research and Therapy. Edited by Max M, Portenoy R, Laska E. 1991, 18:457–473.

  8. Plummer J, Cherry D, Cousins M, et al.: Long-term spinal administration of morphine in cancer and non-cancer pain: a retrospective study. Pain 1991, 44:215–220.

    Article  CAS  PubMed  Google Scholar 

  9. Gourlay GK, Murphy TM, Plummer J, et al.: Pharmacokinetics of fentanyl in lumbar and cervical CSF following lumbar epidural and intravenous administration. Pain 1989, 38:253- 259.

    Article  CAS  PubMed  Google Scholar 

  10. DuPen S, Peterson DG, Williams AR, et al.: Infection during chronic epidural catheterization: diagnosis and treatment. Anesthesiology 1990, 73:905–909.

    Article  CAS  Google Scholar 

  11. DuPen S: Implantable spinal catheter and drug delivery systems: complications. Tech Reg Anesth Pain Manage 1998, 2:152–160. An understanding of the complications of long-term implanted catheters is important for any practitioner considering this therapy. This article covers the possible complications and their identification and treatment. Epidural infection is discussed in detail, and the use of the double epidural filter technique to avoid or lessen the risk for epidural infections is examined.

    Article  Google Scholar 

  12. Hahn MB, Bettencourt JA, McCrea WB: In vivo sterilization of an infected long-term epidural catheter. Anesthesiology 1992, 76:645–646.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Swedish Pain Consultation Service, Swedish Medical Center, 1221 Madison, Suite 410, 98104, Seattle, WA, USA

    Stuart L. DuPen MD

Authors
  1. Stuart L. DuPen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

DuPen, S.L. Epidural techniques for cancer pain management: When, why, and how?. Current Review of Pain 3, 183–189 (1999). https://doi.org/10.1007/s11916-999-0012-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-999-0012-2

Keywords

Search

Navigation