Intractable pain
In the event that pain cannot be controlled, particularly
if dose escalation of opioids is limited by systemic
side effects, epidural or intra-thecal analgesia may be
considered (see section on interventional procedures).
Spinal opioids can be used in combination with local
anesthetic or Clonidine in patients who have intolerable
adverse effects with systemically administered
opioids.133 This route of opioid administration is
only performed by specialists who are skilled in the
procedure and its monitoring. It is most useful in
intractable pain occurring to the lower part of the
body and involves the placement of a delivery system
consisting of a catheter and a port or a pump that can
be internalized for prolonged use.