“…Many of the systemic treatment options are not very effective in alleviating severe pain and increasing doses are often associated with adverse effects including gastrointestinal ulceration (Kallings 1993; Baller & Hendrickson 2002), decreased gut motility (Dart et al. 1997; Bennett & Steffey 2002; Daunt & Steffey 2002; Mama 2002; Senior et al. 2004), renal and hepatic toxicity (Kallings 1993; Baller & Hendrickson 2002), coagulopathies (Moses & Bertone 2002), central nervous excitement (Bennett & Steffey 2002), impaired cardiopulmonary function, metabolic, and urologic side effects (Gross 2001; Daunt & Steffey 2002; Malone & Graham 2002).…”