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To the Editor: Dr Staats and colleagues¹ reported that intrathecal ziconotide was effective at relieving pain among patients with cancer or human immunodeficiency virus (HIV). We have several concerns about this study.

First, pain among patients with cancer may have several different etiologies that may be related to the stage of the disease. Patients with end-stage disease may not represent all patients with cancer, some of whom may experience severe pain early in their disease.

Second, we do not believe that the authors’ 2-week follow-up period is long enough to assess efficacy and the full long-term impact of ziconotide on chronic neuropathic pain or on the variable nature of chronic pain in cancer. Third, we doubt that the investigators were truly blinded to treatment, given the lack of details about allocation concealment, incremental drug titration, adjustment of starting dosage, and "typically dose-related" adverse events.

Fourth, the authors reported a . . . [Full Text of this Article]

Vincenzo Bonicalzi, MD
vbonica@libero.it

Sergio Canavero, MD
Turin Advanced Neuromodulation Group
Turin, Italy

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