[The role of interventional pain therapy in palliative care].

The effective treatment of severe pain requires a multimodal approach with a thorough knowledge of the pharmacological properties of the individual drugs. Non-opioid analgesics are surprisingly effective and compare well to opioids. Due to the pain-induced changes in the spinal cord, the resulting tolerance and the specific effect of tumor mediators on the pain process, an effective treatment strategy requires in 10-30% of the tumor patients in the last weeks of their life an interventional approach to pain management. The common techniques involve neuroaxial delivery of local anaesthetics and opioids. There has been an abundant experience with these techniques in the perioperative setting. The indications are uncontrollable pain states and/or severe side effects of pain therapy including the cognitive deterioration with high dose opioids. The complications are mainly technical and are mostly due to catheter obstruction or disconnection. The increasing use of elastomeric pumps reduces the weight of the reservoir and allows the patient an easy adjustment of the flow rate.