- Contributors
- Preface
- Part I Pain in patients with cancer
- Chapter 1 The principles of management of pain due to cancer
- Part II Treatment of cancer pain
- Chapter 2 The range of treatments for pain due to cancer
- Chapter 3 The development and efficacy of the WHO analgesic ladder
- Part III Opioids in cancer pain
- Chapter 4 Opioid receptors
- Chapter 5 Starting opioids for moderate to severe pain: talking to the patient
- Chapter 6 Principles of opioid titration
- Chapter 7 Management of adverse effects
- Part IV Oral opioids
- Chapter 8 Morphine
- Chapter 9 Oxycodone
- Chapter 10 Hydromorphone
- Chapter 11 Methadone
- Chapter 12 Other alternative oral opioids
- Part V Alternative routes of administration
- Chapter 13 Transdermal opioids
- Chapter 14 Other routes of opioid administration
- Chapter 15 Spinal opioids
- Chapter 16 Parenteral opioids
- Chapter 17 Opioids in special circumstances
- Appendix Dose conversion when switching from oral morphine to transdermal fentanyl
- Index
(p. 110) (p. 111) Spinal opioids
- Author(s):
Karen H. Simpson
and Ganesan Baranidharan
- DOI:
- 10.1093/med/9780199218806.003.0015
Spinal opioids mediate their main actions via mu receptors in the brain and in the substantiagelatinosa within the dorsal horn of the spinal cord. Neuraxial opioids can be very useful when the World Health Organization (WHO) analgesic ladder fails to provide adequate analgesia or leads to unmanageable adverse effects. Intrathecal drug delivery has advantages over epidural drug delivery such as low dose requirements and fewer longer-term complications. Careful patient selection is crucial and should include intrathecal test dosing. Multidisciplinary team work and good post-procedure support are essential for the ongoing management of intrathecal drug delivery to optimize analgesia and manage adverse events.
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- Contributors
- Preface
- Part I Pain in patients with cancer
- Chapter 1 The principles of management of pain due to cancer
- Part II Treatment of cancer pain
- Chapter 2 The range of treatments for pain due to cancer
- Chapter 3 The development and efficacy of the WHO analgesic ladder
- Part III Opioids in cancer pain
- Chapter 4 Opioid receptors
- Chapter 5 Starting opioids for moderate to severe pain: talking to the patient
- Chapter 6 Principles of opioid titration
- Chapter 7 Management of adverse effects
- Part IV Oral opioids
- Chapter 8 Morphine
- Chapter 9 Oxycodone
- Chapter 10 Hydromorphone
- Chapter 11 Methadone
- Chapter 12 Other alternative oral opioids
- Part V Alternative routes of administration
- Chapter 13 Transdermal opioids
- Chapter 14 Other routes of opioid administration
- Chapter 15 Spinal opioids
- Chapter 16 Parenteral opioids
- Chapter 17 Opioids in special circumstances
- Appendix Dose conversion when switching from oral morphine to transdermal fentanyl
- Index