The Management of Pain in Spinal Malignancies

The management of pain caused by malignant involvement of the spine can be challenging. The pain is often multifactorial with somatic and neuropathic elements and may be complicated by pre-existing non-malignant pain from arthritis, spinal stenosis, or other chronic back syndromes. The mechanics of the back increase the likelihood of incident pain that may be particularly difficult to control. Excellent pain management requires a team approach that might include palliative medicine, anesthesia pain management, orthotics, and physical medicine and rehabilitation. This chapter focuses on medical management with opioid and adjuvant analgesic agents.