By Michael J. Cousins (auth.), J. Chrubasik M.D., E. Martin M.D., M. Cousins M.D. (eds.)

Since 1961, whilst ache treatment was once brought by means of Bonica, the- re were world-wide efforts to set up uncomplicated regimens for the remedy of persistent soreness. but many sufferers nonetheless proceed to be afflicted by intractable ache regardless of the availa- bility of powerful remedy that will vastly increase their caliber of lifestyles. the shortcoming of experts conversant in contemporary advancements is without doubt one of the explanations. there's con- sequently an excellent call for for interdisciplinary discomfort clinics and professional education courses. This publication constitutes either a precious creation and an summary of present easy regimens and the most recent subtle ideas in ache therapy.

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Summary More than 10 years have passed since spinal (epidural, intrathecal) opioid treatment was introduced for intractable cancer pain relief. A review of the literature reveals that the success rate of the method is far lower than previously believed, although in most of the patients at least some alleviation of pain is achieved. The success of spinal opioid treatment is dependent on careful patient selection. The pain must be opioid-sensitive and intractable. The patient's physical and mental status should be within the normal range.

Acta Anaesthesiol Scand 26:69-71 2. Andrews CJH, Robertson JA, Chapman JM (1985) Postoperative analgesia with intravenous infusion of alfentanil. Lancet 2:671 3. Arner S, Arner B (1985) Differential effects of epidural morphine in the treatment of cancer-related pain. Acta Anaesthesiol Scand 29:32-36 4. Arner S, Rawal N, Gustafsson LL (1988) Clinical experience of long-term treatment with epidural and intrathecal opioids - a nationwide survey. Acta Anaesthesiol Scand 32:253-259 5. Auld AW, Maki-Jokela A, Murdoch DM (1985) Intraspinal narcotic analgesia in the treatment of chronic pain.

The target having been accurately detected, the ability of the operator determines the limitation of the analgesia to the pain-affected area. The technique met with great success up to 1975, preceding the arrival of the conservative neurophysiological techniques. Until then, it was the most widely used technique and one can estimate the number of cases at approximately 2000 annually in the United States and Canada. However, the indications were limited to unilateral pain distribution due to the major risk of respiratory and sphincter complications arising from bilateral nerve injury.

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