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Management of Cancer Pain—Reply
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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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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.
We agree that celiac plexus block can be effective in patients with intra-abdominal malignancies. Early reports suggested . . . [Full Text of this Article]
Eduardo Bruera, MD
ebruera@mdanderson.org
Department of Palliative Care and Rehabilitation Medicine
University of Texas M. D. Anderson Cancer Center
Houston
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