Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: In their Contempo Updates article
about cancer pain,1 Drs Bruera and Kim stated
that interventional procedures for pain relief should be considered only after
patients "have no improvement in their pain intensity after multiple opioid
trials, adjuvants, and appropriate monitoring of adverse events." Although
the authors cited a recent large randomized controlled trial (RCT) that demonstrated
prolonged survival and enhanced caregiver quality of life with early application
of intraspinal analgesia compared with systemic analgesia,2 they
nonetheless stated that intraspinal analgesia "is not supported by large RCTs."
Burton AW, Rajagopal A, Cleeland CS, Hassenbusch III SJ, Carr DB. Management of Cancer Pain. JAMA. 2004;291(9):1067-1068. doi:10.1001/jama.291.9.1067-b