Intraspinal opioid therapy for intractable cancer pain

THE INTRODUCTION and evolution of intraspinal opioid therapy, a logical outgrowth of the discovery of opioid receptors, has dramatically altered contemporary cancer pain management over a remarkably short period of time. Intraspinal opioid therapy is considered for patients unable to achieve adequate comfort with the application of standard pharmacologic interventions, or when side effects prevail. Unlike classic ablative interventions, cost-effective screening can be performed, and effects are titratable and reversible. Side effects and complications occur in only a modest proportion of patients. Various novel drug delivery systems have been developed, increasing the feasibility of long-term use.