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Epidural/intrathecal analgesia in palliative and end-of-life care
  1. Christopher Clarkson, Staff Nurse
  1. Trevor Howell Ward, St George’s Hospital, London. At the time of writing, he was BSc (Hons) Nursing (Adult) Student, Florence Nightingale School of Nursing and Midwifery, King’s College London. Email: chrisclarkson{at}


For the majority of palliative care patients who experience pain, the recommendations made by the World Health Organization in its analgesic ladder should ensure adequate pain relief. However, a minority will require epidural or intrathecal spinal analgesia. Following a student placement at St Christopher’s Hospice, London, the author became interested in the administration of epidural and intrathecal analgesia, specifically for use within the adult palliative care environment. A literature search showed that epidural and intrathecal analgesia does provide pain relief for the majority of palliative care patients who have not had their pain adequately relieved by conventional systemic methods. This article examines the effectiveness of spinal analgesia, looking specifically at its role in the relief of pain, its associated complications and the psychological impact of this invasive therapy. Current research and guidelines deal with spinal therapy in hospital and hospice settings only. It is recommended that these guidelines should be expanded to allow for discharge into the community of patients with a spinal catheter in place. Conflicts of interest: none

  • Analgesia
  • Epidural
  • Intrathecal
  • Pain
  • Palliative and end-of-life care

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