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Letters
March 3, 2004

Management of Cancer Pain—Reply

Author Affiliations
 

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

JAMA. 2004;291(9):1067-1068. doi:10.1001/jama.291.9.1068-c

In Reply: In response to Dr Burton and colleagues, the recent large RCT of intraspinal analgesia described in our article and their letter included only patients with "refractory cancer pain."1 This industry-sponsored study had a number of previously discussed limitations,2,3 including the absence of appropriate blinding of both patients and investigators. In patients selected as having failed to respond to conventional care, there was a mean (SD) reduction in the 4-week pain score of 3.05 (3.16) in the conventional-care group compared with 3.90 (4.42) in the group that received intraspinal analgesia (P = .06).1 We believe these findings are inconclusive and more research is needed to better understand the role of intrathecal opioids. We do not think that the literature provides strong evidence that early interventional procedures are better than conventional treatment.

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