{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T20:20:58Z","timestamp":1790713258354,"version":"4.1.0"},"reference-count":77,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,7,16]],"date-time":"2023-07-16T00:00:00Z","timestamp":1689465600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Epidural analgesia is a common technique for managing perioperative and obstetric pain. Patients with cancer who cannot tolerate opioids or not responding to conventional treatment may benefit from epidural analgesia. Therefore, this systematic review aimed to analyze the efficacy and safety of epidural analgesia in patients with intractable cancer pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify studies on patients with cancer who received epidural analgesia. We assessed the quality of all included studies using the risk\u2010of\u2010bias tool or Newcastle\u2010Ottawa scale. The primary outcome was pain relief after epidural analgesia, and the secondary outcome was quality of life, analgesic consumption, and adverse events. The studies were grouped based on the medications used for epidural analgesia. A descriptive synthesis was performed following the Synthesis Without Meta\u2010analysis reporting guideline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Our systematic review included nine randomized controlled trials (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009340) and 15 observational studies (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009926). Two randomized controlled trials suggested that epidural opioids were not superior to systemic opioids in relieving pain. Epidural opioids combined with local anesthetics or adjuvants, including calcitonin, clonidine, ketamine, neostigmine, methadone, and dexamethasone, offered better analgesic effects. No significant difference in pain relief between an intermittent bolus and a continuous infusion of epidural morphine was observed. Epidural opioids had more analgesic effects on nociceptive pain than neuropathic pain. The methods used to evaluate the quality of life and the corresponding results were heterogeneous among studies. Six observational studies demonstrated that some patients could have decreased opioid consumption after epidural analgesia. Adverse events, including complications and drug\u2010related side effects, were reported in 23 studies. Five serious complications, such as epidural abscess and hematoma, required surgical management. The heterogeneity and methodological limitations of the studies hindered meta\u2010analysis and evidence\u2010level determination.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Coadministration of epidural opioids, local anesthetics, and adjuvants may provide better pain relief for intractable cancer pain. However, we must assess the patients to ensure that the benefits outweigh the risks before epidural analgesia. Therefore, further high\u2010quality studies are required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/papr.13273","type":"journal-article","created":{"date-parts":[[2023,7,16]],"date-time":"2023-07-16T22:53:38Z","timestamp":1689548018000},"page":"956-969","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Efficacy of epidural analgesia for intractable cancer pain: A\u00a0systematic review"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7242-3796","authenticated-orcid":false,"given":"Yu\u2010Lien","family":"Hsieh","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine National Cheng Kung University  Tainan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui\u2010Yu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine National Cheng Kung University  Tainan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chung\u2010Ren","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine National Cheng Kung University  Tainan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi\u2010Fei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine National Cheng Kung University  Tainan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,7,16]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2021.09.011"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.56.0383"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2015.12.340"},{"issue":"7","key":"e_1_2_11_5_1","article-title":"Opioids for cancer pain \u2013 an overview of Cochrane reviews","volume":"7","author":"Wiffen PJ","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdy152"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2009.12.023"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000002130"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2009.06.012"},{"key":"e_1_2_11_10_1","volume-title":"WHO guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents","author":"World Health O","year":"2018"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-019-01482-w"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000935"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000237"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e318220847c"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/aas.12485"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269216310386279"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1411"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-010-9491-z"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-14-45"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l6890"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.1988.tb02711.x"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(91)90196-5"},{"issue":"3","key":"e_1_2_11_24_1","first-page":"163","article-title":"Effects of epidural sufentanil and a sufentanil\/bupivacaine mixture on the quality of life for chronic cancer pain patients","volume":"6","author":"Boersma FP","year":"1993","journal-title":"Pain Clinic"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0011-393X(05)80694-0"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(94)00209-W"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(96)03161-2"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0952-8180(99)00122-1"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348940010900711"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2012.593"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.1985.tb02155.x"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01731174"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19870301)59:5<986::AID-CNCR2820590523>3.0.CO;2-C"},{"issue":"6","key":"e_1_2_11_34_1","first-page":"293","article-title":"Epidural sufentanil for cancer pain control in outpatients","volume":"14","author":"Boersma FP","year":"1989","journal-title":"Reg Anesth"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1990.73.3.0405"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(91)90182-W"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(91)90110-J"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(91)90025-S"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(92)90234-3"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(92)90083-N"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19981101)83:9<2015::AID-CNCR19>3.0.CO;2-R"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.3349\/ymj.2012.53.3.649"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.5505\/agri.2014.14227"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.3344\/kjp.2014.27.2.139"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sjpain.2017.04.073"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aen105"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000001688"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/ael217"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000000077"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pny132"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e3181bfab9a"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199403033300926"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199401000-00021"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.290.18.2455"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2021.770694"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200408000-00031"},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ANE.0000117146.46373.51"},{"key":"e_1_2_11_58_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.2005.00638.x"},{"key":"e_1_2_11_59_1","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0b013e31818e61b8"},{"key":"e_1_2_11_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/0885-3924(94)90200-3"},{"key":"e_1_2_11_61_1","doi-asserted-by":"publisher","DOI":"10.1111\/papr.12957"},{"key":"e_1_2_11_62_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-200105000-00040"},{"key":"e_1_2_11_63_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200610000-00028"},{"key":"e_1_2_11_64_1","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0b013e32836249e9"},{"issue":"3","key":"e_1_2_11_65_1","first-page":"139","article-title":"Effect of adding calcitonin to translaminar epidural steroid in degenerative lumbar spinal canal stenosis","volume":"19","author":"Elsheikh NA","year":"2016","journal-title":"Pain Physician"},{"key":"e_1_2_11_66_1","doi-asserted-by":"publisher","DOI":"10.1517\/14656566.2014.925446"},{"key":"e_1_2_11_67_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000002238"},{"key":"e_1_2_11_68_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2010.01.013"},{"key":"e_1_2_11_69_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(93)90161-H"},{"key":"e_1_2_11_70_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200210000-00033"},{"key":"e_1_2_11_71_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2011.01.001"},{"key":"e_1_2_11_72_1","doi-asserted-by":"publisher","DOI":"10.1111\/ner.12538"},{"key":"e_1_2_11_73_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aen360"},{"key":"e_1_2_11_74_1","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000286"},{"key":"e_1_2_11_75_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-013-0075-8"},{"issue":"1","key":"e_1_2_11_76_1","first-page":"94","article-title":"A comparison of epidural catheters with or without subcutaneous injection ports for treatment of cancer pain","volume":"78","author":"Jong PC","year":"1994","journal-title":"Anesth Analg"},{"key":"e_1_2_11_77_1","doi-asserted-by":"publisher","DOI":"10.1177\/2049463712439256"},{"key":"e_1_2_11_78_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD"}],"container-title":["Pain Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/papr.13273","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,9]],"date-time":"2023-11-09T06:06:44Z","timestamp":1699510004000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/papr.13273"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,16]]},"references-count":77,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1111\/papr.13273"],"URL":"https:\/\/doi.org\/10.1111\/papr.13273","archive":["Portico"],"relation":{},"ISSN":["1530-7085","1533-2500"],"issn-type":[{"value":"1530-7085","type":"print"},{"value":"1533-2500","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,16]]},"assertion":[{"value":"2022-09-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}