Cancer patients: special considerations

Despite advances in understanding the pathophysiology of pain associated with cancer and the implementation of aggressive therapies with oral/transdermal medications, many patients do not achieve adequate analgesia. Intraspinal drug-delivery techniques have been successful in providing adequate pain control for these patients. However, there are several caveats in attaining this goal. The site of the tip of the catheter is of paramount importance. It must be placed close to the spinal segment corresponding to the site of nociception. Moreover, the use of bupivacaine and/or clonidine will not only enhance the quality of analgesia but will also decrease the incidence of opiate-induced side effects. Implementing protocols for the management of these patients with intraspinal techniques will not only yield better analgesia in patients unresponsive to oral pharmacologic therapy, but may also be associated with improved survival. This study examines the implementation of intraspinal therapy in patients with oncologic pain unresponsive to oral pharmacologic therapy.