Epidural nonsteroidal antiinflammatory drugs for cancer pain.

A lthough pain relief with multimodal therapy is excellent in 45%-90% of cancer patients (l), dose escalation eventually occurs. The concurrent use of nonsteroidal antiinflammatory drugs (NSAIDS) to enhance opioid effects while decreasing the dose is recommended. Should NSAIDS and opioids fail, the spinal administration of opioids often results in improved analgesia with reduced opioid side effects w. Several reports have suggested a spinal site of action for NSAIDS (3-7) and synergy with spinal morphine (5). However, appropriate preclinical toxicity testing has not been performed for any commercially available NSAID, and intraspinal application is premature (8). We describe two cases in which epidural NSAIDS were administered by our ambulatory cancer patients without our initial knowledge or approval.

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