Early studies in cancer-related pain demonstrated that intrathecal administration of opioids was much more effective than other routes of administration.3'610'20'25 The most common early use of intrathecal infusion of morphine was in cancer-related pain. In a retrospective multicenter study of the use of intraspinal morphine for all types of pain, 32.7% of the patients analyzed had cancer pain.25 The average length of treatment in the study was 14.6 months (8-94 months). Cancer patients were treated with higher initial doses and escalated to a stable level more rapidly than patients with non-cancer-related pain. The most frequently used drug was morphine. In the cancer population 13.6% had somatic pain, 25.4% neuropathic pain, 16.9% visceral pain, and 44.1% a mixed pain presentation. The long-term stability of dosing in the cancer population has also been documented elsewhere.31 Cancer pain of all types remains an excellent indication for the use of intrathecal opioids especially in the case of a programmable pump, which can aid in the matching of pain relief to progression of disease. It is probable that about 5 to 10% of those in the cancer pain population are candidates for an implantable pump system using the selection criteria noted earlier.
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