Epidural Techniques for Cancer Pain Management: When, Why, and How?

Epidural analgesia is an important tool in the management of intractable cancer pain. Fundamental questions surrounding the use of epidural catheters in cancer pain management include: When is epidural analgesia appropriate?, Why is epidural analgesia beneficial?, and How does the clinician implement and manage epidural catheters in patients with cancer pain? This clinical review addresses these questions through a discussion of patient selection criteria, the advantages and disadvantages of the epidural route, the concept of functional analgesia, cost issues, device selection, treatment planning, and complications. The author concludes that achieving an optimal outcome with epidural techniques in a patient with cancer involves a negotiation between patient and provider.