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March 3, 2004

Management of Cancer Pain

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(9):1067-1068. doi:10.1001/jama.291.9.1067-b

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."

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