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To the Editor: Drs Bruera and Kim¹ did not mention intrathecal opioid infusion, which can be used to manage cancer pain while avoiding many of the usual opioid-related adverse effects.^2-4

Joshua M. Rosenow, MD
jrosenow@nmff.org
Department of Neurosurgery
Northwestern University Feinberg School of Medicine
Chicago, Ill

1. Bruera E, Kim HN. Cancer pain. JAMA. 2003;290:2476-2479. FREE FULL TEXT 2. Paice JA, Penn RD, Shott S. Intraspinal morphine for chronic pain: a retrospective, multicenter study. J Pain Symptom Manage. 1996;11:71-80. FULL TEXT | ISI | PUBMED 3. Smith TJ, Staats PS, Deer T, et al, for the Implantable Drug Delivery Systems Study Group. Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. J Clin Oncol. 2002;20:4040-4049. FREE FULL TEXT 4. Anderson VC, Burchiel KJ. A prospective study of long-term intrathecal morphine in the management of chronic nonmalignant pain. Neurosurgery. 1999;44:289-300; discussion 300-301. FULL TEXT | ISI | PUBMED

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

JAMA. 2004;291:1068.

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