Review article : The spinal administration of opioids in the treatment of acute and chronic pain: bolus doses, continuous infusion, intraventricular administration and implanted drug delivery systems

Abstract

The spinal administration of opioids has been a significant addition to the previously available alternatives for pain control for patients with pain related to cancer. This article does not debate the more widespread use of these techniques in patients with nonmalignancy related pain. The incidence of destructive neurolytic procedures has fallen in most centres where spinal opioids have been administered. Some types of cancer pain have proved to be more effectively controlled than others, but in most circumstances potentially reversible procedures, such as outlined in this article, should be given a therapeutic trial before embarking on neuro-destructive procedures.1 It should be reemphasized however, that the spinal route of administration should be instituted only after systemically administered opioids have been shown to be ineffective or associated with intolerable side effects.