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Management of Cancer Pain
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| Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings. |
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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."
The authors also did not discuss the widely used neurolytic celiac plexus block, whose prolonged efficacy in decreasing pain intensity and/or systemic opioid intake in patients with abdominal malignancy has been supported by a recent systematic review.2 Other invasive procedures not mentioned include vertebroplasty and radiofrequency ablation of bony metastasis. Furthermore, the authors' statement "that all of these interventions are complex . . . [Full Text of this Article]
Allen W. Burton, MD
awburton@mdanderson.org
Arun Rajagopal, MD;
Charles S. Cleeland, PhD
Department of Symptom Research
Samuel J. Hassenbusch III, MD, PhD
Department of Neurosurgery
University of Texas M. D. Anderson Cancer Center
Houston
Daniel B. Carr, MD
Department of Anesthesiology
Tufts-New England Medical Center
Boston, Mass
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