OUTCOMES OF EPIDURAL MORPHINE TREATMENT IN CANCER PAIN - 9 YEARS OF CLINICAL-EXPERIENCE

The outcome of epidural morphine therapy is described in 146 consecuti ve cancer patients who were treated by a community hospital-based pain service. The routine procedure used a standard epidural catheter that was tunneled subcutaneously. One hundred and twenty-one patients impr oved and stayed on. lifelong or chronic epidural opioids. Mean treatme nt time was 92 days (medium, 47; range, 2-2040); 49% of the time was s pent as outpatients. Twenty-five patients failed to respond to the tre atment. The oral daily morphine-equivalent dose prior to inclusion was 164 mg. The mean daily epidural start dose of morphine was 18 mg (ran ge, 6-120), and the mean daily dose at termination was 69 nag(range, 2 -540). The dose escalations, described as the ratio of the maximum dos e to the minimum maintenance start dose, were moderate, with a mean of 4.1 (median, 2.5), which corresponded to a percent increase of 5.1 (m edian 2.7) per patient pm day. Lack of effect due to the character of the original symptoms or progression of pain was the main reason for w ithdrawal from epidural opioid therapy (N = 27), followed by catheter- related problems (N = 9) and drug-related complications (N = 5). Also due to drug-related complications, epidural morphine therapy was chang ed to buprenorphine or methadone in 19 patients. Adjuvant systemic opi oids were given to ten patients and epidural focal anesthetics were ad ministered to 17 of the subjects. Neuropathic pain, certain visceral p ain types, incident pain. on movement, and pain from cutaneous ulcerat ions were characterestics of poor responders. We conclude that epidura l morphine therapy can be an effective alternative in the treatment of cancer pain. Lack of therapeutic efficacy due to the specific charact er of pain and not drug-related or catheter-related complications repr esented the major reason for treatment withdrawal.