Extended epidural catheter infusions with analgesics for patients with noncancer pain at their homes

Background and Objectives. Patients with severe, noncancer pain unresponsive to epidural steroid injections are frequently referred for implantation of a permanent intraspinal device or for surgery. An alternative approach has been evaluated, which involves extended epidural catheter infusions of analgesics. Methods. Observations were made in 551 adult patients with severe low back pain due to a variety of nonmalignant causes, who were treated in an ambulatory setting with a total of 3,108 temporary lumbar epidural catheter infusions of low-dose bupivacaine and fentany via disposable infusion pumps. Results. All but a few treatments resulted in good to excellent pain relief, and most permitted patients to increase their physical activities to near normal levels. The cost of this approach was lower than that associated with insertion of an implantable infusion pump. Conclusions. Temporary lumbar epidural catheter infusions represent an option between lumbar epidural steroid injections and more invasive and expensive modalities. The technique is effective in relieving chronic low back pain for extended periods, reducing its long-term intensity, and in some cases abolishing it.