On this page: Epidural or spinal medicines | Nerve block | Other pain relief methods
Sometimes pain can be difficult to relieve completely with medicines. In these situations, your doctor may suggest you see
a pain medicine specialist in a multidisciplinary pain clinic. They may recommend the following therapies.
Epidural or spinal medicines
Sometimes to control pain, morphine is used in such high doses that severe side effects can occur. However, delivering the morphine directly onto the nerves in the spine via a tube (catheter) causes fewer side effects. Other drugs can also be added to improve pain control. Spinal medicine can be given in a number of ways:
Tunnelled spinal catheter
A small tube put in the space around the spinal cord and then tunnelled out to the body’s surface through the skin. The tube is attached to an external syringe pump, which delivers the medicine (e.g. anaesthetic and/or opioid). Medicine may be delivered in a single dose, as
a continuous infusion, or using a combination of these methods.
Port-a-cath spinal system
The tunnelled catheter is attached to the skin of the chest or abdomen through an opening (port), which allows needles and bags of pain relief to be inserted. Usually a nurse needs to replace the bags every 1–2 days.
Tunnelled spinal catheter and pump
The catheter is connected to a pump that is implanted in the fatty tissue of
the abdominal area. The pump is refilled every three months with a needle through the skin into the pump’s port.
Injecting a local anaesthetic into or around a nerve will stop that
nerve from sending (transmitting) pain messages. This is called
a nerve block, and the effect is temporary. There are different types
of nerve blocks. Sometimes nerves to part of the bowel or pancreas
can be blocked to provide pain relief, especially in pancreatic
cancer. This is called a coeliac plexus block.
Other pain relief methods
Your specialist may suggest one or more of the following options:
behaviour therapy (CBT)
A talking therapy that guides
people to change the way
they cope with the pain and
to resume normal activity as
much as possible.
Apsychological technique that
involves focusing on the pain
and relaxing at the same time;
it is used for neuropathic pain
(e.g. numbness or tingling).
Helps reprogram the brain
(e.g. dealing with phantom
limb pain after an amputation).
Uses heat to destroy
the nerves causing pain.
pulses to change nerve
activity; the pulses cause the
body to release a substance
that stops feelings of pain
from nerve damage (e.g. after
or radiotherapy, and for
Surgery to the brain or
In rare cases,
you may have neurosurgery
to relieve pain.
Reviewed by: Dr Melanie Lovell, Clinical Ass Prof, Medicine, Northern Clinical School, Sydney Medical School, University of Sydney, and Palliative Medicine Consultant Physician, Greenwich Hospital, NSW; Nathaniel Alexander, 13 11 20 Consultant, Cancer Council NSW, NSW; Anne Booms, Palliative Care Nurse Practitioner, Canberra Hospital, ACT; Dr Roger Goucke, Consultant, Department of Pain Management, Specialist Pain Medicine Physician, Sir Charles Gairdner Hospital, and Clinical Ass Prof, School of Medicine and Pharmacology, University of Western Australia, WA; John Marane, Consumer; and Dr Jane Trinca, Director, Barbara Walker Centre for Pain Management, St Vincent’s Hospital, VIC.