CONTROVERSIES OVER SPINAL TREATMENT IN ADVANCED CANCER-PATIENTS

About 10% of patients with cancer pain do not obtain pain relief or ex perience unacceptable side effects with systemic opioids. In some case s a change of the route of administration can improve the balance of a nalgesia and adverse effects. In this paper the use of spinal opioids in such patients is discussed from various aspects: patient selection, epidural vs intrathecal administration, dosage, association with loca l anaesthetic agents, dosage conversion systems (for the change from s ystemic administration) and home use. The main problems involved are d ealt with an attempt to find how to use the drugs and techniques invol ved to the best possible advantage.