# Reconsidering neuraxial analgesia at end of life: Clinical, ethical, and socioeconomic perspectives

## TL;DR

This paper discusses the underused potential of neuraxial analgesia for end-of-life pain management, highlighting clinical, ethical, and socioeconomic factors.

## Contribution

The paper reframes neuraxial analgesia as a legitimate end-of-life care option, addressing barriers to its adoption.

## Key findings

- Neuraxial analgesia provides targeted pain relief with fewer systemic side effects compared to opioids.
- Barriers to neuraxial analgesia include clinical, ethical, and socioeconomic challenges.
- Reframing these interventions can lead to more equitable access in end-of-life care.

## Abstract

Pain is one of the most prevalent and distressing symptoms experienced by patients nearing end of life, particularly among those with cancer. While systemic opioids are the mainstay of treatment, their limitations necessitate consideration of alternative strategies. Neuraxial analgesia, including epidural and intrathecal drug delivery systems, offers targeted pain relief with reduced systemic burden. Yet despite supportive data, these interventions remain underutilized due to clinical, ethical, logistical, and socioeconomic barriers. This article examines the complex decision-making involved in offering neuraxial analgesia at the end of life, weighing risks and benefits, shifting patient goals, and the challenges of care coordination. By reframing neuraxial analgesia not as an extraordinary measure, but as a legitimate and potentially transformative option, we advocate for broader, more equitable integration of these therapies.