Correspondence

More on the Treatment of Pain

N Engl J Med 1994; 331:1528December 1, 1994

Article

To the Editor:

In regard to the letters to the editor (July 21 issue)1 about the excellent article by Cleeland et al. (March 3 issue),2 we were surprised, as neurosurgeons treating chronic pain and pain from cancer, at the lack of attention to the surgical options for treating cancer pain. The surgical armamentarium for pain control is vast and includes implantable drug-delivery devices, chemical and radiofrequency rhizotomies, central nervous system pathway disconnections and augmentation, open decompression of symptomatic nerve roots or peripheral nerves, and spinal stabilization.3 Recently, even radiosurgical ablation of nuclei and pathways in the central nervous system has proved feasible and useful in patients who are unable to undergo traditional open surgical procedures.4 It is important that medical oncologists, radiation oncologists, and neurosurgeons work in concert to relieve the suffering of patients with cancer.

Antonio A.F. De Salles, M.D., Ph.D.
J. Patrick Johnson, M.D.
UCLA School of Medicine, Los Angeles, CA 90024-6975

4 References

1. 1

   Treating cancer painN Engl J Med 1994;331:199-201
   Full Text | Medline

2. 2

   Cleeland CS, Gonin R, Hatfield AK, et al. Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 1994;330:592-596
   Full Text | Web of Science | Medline

3. 3

   Sundaresan N, DiGiacinto GV, Hughes JE. Neurosurgery in the treatment of cancer pain. Cancer 1989;63:Suppl:2365-2377
   CrossRef | Web of Science | Medline

4. 4

   De Salles AAF, Hariz M. Functional radiosurgery. In: De Salles AAf, Goetsch JJ, eds. Stereotactic surgery and radiosurgery. Madison, Wis.: Medical Physics, 1993:389-406.