Indication for epidural morphine for the relief of intractable pain in advanced oral cancer: report of four cases

It can be difficult to manage the pain of advanced oral cancer. We present four patients in whom epidural morphine was used for intractable pain at pr imary or metastatic sites. For pain supplied by the trigeminal or cervical nerve a small dose of morphine was given through an epidural catheter inser ted into the epidural space through C7-Th1. A favourable clinical response was achieved in three. In particular, in one patient who was given continuo us morphine using a computerized ambulatory drug delivery system, we achiev ed excellent efficacy and stable control of pain. We think that the effect of the epidural morphine was decreased in the patient who did not respond b ecause he had previously been treated with high oral doses. The present stu dy confirmed that morphine given epidurally in small doses has a strong and prolonged analgesic action with less toxicity than when given orally. (C) 2000 The British Association of Oral and Maxillofacial Surgeons.