When all else fails: stepwise multiple solutions for a complex cancer painsyndrome

In the presence of insufficient pain relief and substantial adverse effects , application of alternative routes of administration and a change of opioi d are the main methods used to improve the analgesic response. When all els e fails, the result may further be optimized using adjuvant drugs by an alt ernative route, namely the intrathecal route. A stepwise approach with mult iple drugs and routes of administration is described. This was implemented to resolve a complex pain syndrome otherwise considered uncontrollable. We found it possible to manage a very difficult pain situation by intrathecal home infusion through the efforts of a well-trained family and GP and a con tinuous exchange of information and advice with the pain relief team about changes in therapy to adapt to the clinical situation. A stepwise and a mea ningful approach to clinical problems with use of advanced techniques and a lternative drugs in the patient's home may be helpful in the treatment of c onditions otherwise considered intractable.