Analgésie périmédullaire dans la douleur cancéreuse

Spinal and epidural analgesia, often used in treating cancer pains that are refractory to classical analgesic treatment, consists in a lengthy administration of certain centrally active molecules (morphinic, in particular) at an epidural or intrathecal level. This treatment aims to increase these antalgics' effectiveness. Principles, indications, most commonly used molecules, and practical implementations of spinal analgesia are discussed by way of a review of recent literature and American consensus conferences treating the subject. The choice of molecules is based principally on the physiopathological mechanism behind cancer pains, a mechanism that is rarely singular. Associations of molecules are commonly used since they reduce the required level of medication and permit an optimization of the antalgic. The choice of the perfusion method and device (external or implanted) depends on the state of the pain syndrome and the vital prognosis. The complexity of cancer pains and their interaction with the patient's psychic condition justifies validating the indications from a multidisciplinary perspective. While some molecules are still being studied, others are used as a last resort because of a lack of clinical evidence. In the years to come, the use of these molecules will likely contribute to current pharmacopoeia. Finally, a few national recommendations seem necessary in order to facilitate the practice of spinal and epidural analgesia in oncology.