Stephen J.LurieMD, PhD, Senior Editor
To the Editor: In his Clinical Crossroads article, Dr Koenig1 discussed an elderly woman with chronic illness and strong religious beliefs. Although the article's purpose was to illuminate research that shows religious beliefs can have a therapeutic effect on chronic illness, we are concerned that some pain treatment options were not explored.
The patient's medical history reveals that her care team unsuccessfully tried many different treatment regimens; however, the article does not mention whether she was ever referred to a pain specialist. There are many other anticonvulsants, antidepressants, and opioids that have demonstrated a therapeutic benefit for some types of neuropathic pain.2- 4 Implantable therapies, including spinal cord stimulation and intrathecal infusions, might also be helpful in carefully selected patients.5 In addition, specific psychological interventions can be effective in treating severe chronic pain.6
Burton AW, Arens JF. Spirituality and Chronic Illness. JAMA. 2002;288(20):2541. doi:10.1001/jama.288.20.2541-JLT1127-3-1