Pain Medicine 2015; 16: 18 Wiley Periodicals, Inc.
Letters to the Editor Reader Responses to the Ethics Forum: Room for Multiple Perspectives In a recent Ethics Forum [1], Drs. John Loeser and Tim Deer opined on a case study involving the question of whether a patient should be considered for the implantation of an intrathecal opioid pump. While Dr. Loeser, who has been a critic of intrathecal opioids, recommended against implantation, Dr. Deer surprised many readers by also questioning the prudence of implantation in this particular patient. As a luminary in the field of neuromodulation, this was hardly the position expected of Dr. Deer. Shortly after the publication of the Forum, we received a letter from Dr. Michael Verdolin, who suggested a paradigmatic revision of the traditional highdosage approach to intrathecal opioid therapy. Drs. Loeser and Deer were kind enough to provide us with their responses to Dr. Verdolin’s letter. Finally, we recently received a letter from Drs. Daniel Doleys and Maged Hamza, who commented on the oral/intrathecal opioid relationship, the role of extraneous variables in assessing intrathecal opioid efficacy, and intrathecal opioids as only a single element in the very complex process of managing chronic pain. We have chosen to publish all of these letters, as we believe that they each serve to further our understanding of intrathecal opioid therapy as well as chronic pain management more broadly considered. We are pleased to provide a forum for rich public discussion of controversial topics in the field of pain management. The pur-
18
pose of the Ethics Forum is clearly not to provide the “ethical answer” to the dilemmas with which clinicians and policy-makers are faced on a daily basis. Rather, our intention is to provoke thought and consideration of alternative approaches to the practice of pain medicine. We thank Drs. Verdolin, Doleys and Hamza – and of course Drs. Loeser and Deer – for their contributions, and hope that other readers will shed their reticence and follow their examples by weighing in on future controversial topics that we address.
MICHAEL E. SCHATMAN, PhD, CPE* and BETH D. DARNALL, PhD† Ethics Forum Section Co-Editors *Foundation for Ethics in Pain Care, Bellevue, Washington; †Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
Reference 1 Schatman ME, Darnall DB, Loeser JD, Deer TR. Intrathecal opioids for chronic nonmalignant pain: a case study and the search for balance. Pain Med. 2014;15:1268-71
Copyright of Pain Medicine is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Letters to the Editor Reader Responses to the Ethics Forum: Room for Multiple Perspectives In a recent Ethics Forum [1], Drs. John Loeser and Tim Deer opined on a case study involving the question of whether a patient should be considered for the implantation of an intrathecal opioid pump. While Dr. Loeser, who has been a critic of intrathecal opioids, recommended against implantation, Dr. Deer surprised many readers by also questioning the prudence of implantation in this particular patient. As a luminary in the field of neuromodulation, this was hardly the position expected of Dr. Deer. Shortly after the publication of the Forum, we received a letter from Dr. Michael Verdolin, who suggested a paradigmatic revision of the traditional highdosage approach to intrathecal opioid therapy. Drs. Loeser and Deer were kind enough to provide us with their responses to Dr. Verdolin’s letter. Finally, we recently received a letter from Drs. Daniel Doleys and Maged Hamza, who commented on the oral/intrathecal opioid relationship, the role of extraneous variables in assessing intrathecal opioid efficacy, and intrathecal opioids as only a single element in the very complex process of managing chronic pain. We have chosen to publish all of these letters, as we believe that they each serve to further our understanding of intrathecal opioid therapy as well as chronic pain management more broadly considered. We are pleased to provide a forum for rich public discussion of controversial topics in the field of pain management. The pur-
18
pose of the Ethics Forum is clearly not to provide the “ethical answer” to the dilemmas with which clinicians and policy-makers are faced on a daily basis. Rather, our intention is to provoke thought and consideration of alternative approaches to the practice of pain medicine. We thank Drs. Verdolin, Doleys and Hamza – and of course Drs. Loeser and Deer – for their contributions, and hope that other readers will shed their reticence and follow their examples by weighing in on future controversial topics that we address.
MICHAEL E. SCHATMAN, PhD, CPE* and BETH D. DARNALL, PhD† Ethics Forum Section Co-Editors *Foundation for Ethics in Pain Care, Bellevue, Washington; †Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
Reference 1 Schatman ME, Darnall DB, Loeser JD, Deer TR. Intrathecal opioids for chronic nonmalignant pain: a case study and the search for balance. Pain Med. 2014;15:1268-71
Copyright of Pain Medicine is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
