Cervical versus Thoracic Epidural Morphine for the Treatment of Head and Neck Cancer Pain

Abstract

We studied 29 patients in the final stage of head or neck cancer who were suffering pain that was not relieved by oral morphine. Cervical or thoracic epidural morphine was administered to relieve the pain. The quality of analgesia was equally good for both techniques. However, cervical epidural administration appeared to be superior, because much smaller doses of morphine were required in order to induce more rapid and longer analgesia.

Intraspinal techniques for pain management in cancer patients: a systematic review

“…Systematic reviews, consensus conferences, and randomized controlled trials Three systematic reviews [5][6][7], three consensus conferences [8][9][10], and 12 RCTs [11][12][13][14][15][16][17][18][19][20][21][22] met the selection criteria of studies examining clinical effectiveness. Although the systematic reviews and consensus conferences included some relevant RCTs, no single systematic review or consensus conference included all relevant RCTs or sufficiently discussed the effectiveness of intraspinal analgesia for cancer-related pain to support recommendations.…”

“…Giorgiou [22] evaluated epidural administration of morphine in the thoracic compared with the cervical region and showed no difference in pain scores. The cervical route required smaller bolus doses and gained longer lasting analgesia than the thoracic route.…”

Pharmacological and Other Interventions for Head and Neck Cancer Pain: a Systematic Review

“…Werner et al [45] reported the highest drop out rate in the intervention group (56.1%) and in the placebo group (82.9%). The lowest drop out rate was stated with 0% [39,40,44,46]. …”

“…Five out of 13 studies were conducted in European countries [39-42,46] and 4 in the United States and Canada [27,38,47,48], two in India [43,44] and one further publication enrolled patients from Europe and Israel [45]. …”

“…Jovic et al [41] reported that Ketoprofen was superior to Metamizole in controlling post-surgical pain, however this was only statistically significant on day three of treatment (P < 0.05). Cervical epidural Morphine was shown to provide longer lasting analgesia compared to thoracic epidural by Georgiou et al [39] while also requiring smaller doses. McNeely et al [47] reported in 2004 that patients in the PRET group had an overall decrease in pain score of 17% compared to an increase of 1.7% in the control group.…”