Epidural and intrathecal analgesia for cancer pain in patients with difficulty tolerating systemic opioid therapy: A retrospective study of 53 cases

Intrathecal analgesia (ITA) is often administered to patients with cancer receiving high–dose systemic opioids. However, in some patients, opioid escalation is challenging even at relatively low doses owing to adverse effects, despite inadequate analgesia. This retrospective study evaluated the effectiveness of neuraxial analgesia and subsequent clinical outcomes in patients with cancer pain who had difficulty tolerating systemic opioid therapy. Among 158 patients who underwent ITA between January 2021 and March 2025, 53 patients with oral morphine equivalents (OME) <200 mg/day were included and followed until death. Pain scores (numerical rating scale [NRS] scores), medication dose changes, home discharge outcomes, survival after ITA, and adverse events were analyzed. Epidural analgesia (EPI) preceded ITA in 52 patients. Median NRS significantly improved from 8 (6–10) before neuraxial analgesia to 1 (0–2) at 2 weeks after ITA (P < 0.001). Median systemic OME decreased from 40 mg/day to 0 mg/day (P < 0.001). Overall, 66% of patients returned home at least once, and 47% died at home. Survival after ITA tended to be shorter in patients with gastrointestinal cancers, whereas greater variability was observed in patients with urinary tract cancers. In patients with cancer pain that was difficult to manage with systemic opioid therapy, stepwise neuraxial analgesia with epidural and intrathecal approaches was associated with substantial pain reduction. Neuraxial analgesia may be considered a therapeutic option in selected patients who are unable to achieve adequate pain control with conventional systemic therapy.