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Pain Management in Patients with Advanced Cancer
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
IN RESPONSE:
I agree with Dr. Berland that methadone is a very useful agent for some patients with cancer who have a steady level of pain, although I have had less success than he has in obtaining patient acceptance. I also find it difficult to obtain the liquid form for patients who are not participating in methadone maintenance programs. Although I agree with most of the reasons he cites, readers should be aware that a Food and Drug Administration-approved formulation of sustained-release morphine (Kadian, Faulding Laboratories, Raleigh, North Carolina) is available for suspension in water and placement in feeding tubes (1).
A more thorough discussion of the benefits of methadone was not included in my paper because at the time of its writing, Ripamonti and colleagues' paper (which is cited as reference 84) was the only paper discussing the complicated equianalgesic dosing of methadone for patients taking moderate to high doses of morphine. The other current published tables refer only to conversions of low doses of morphine to methadone. As Dr. Bernard states, incorrect conversions from morphine to methadone at higher doses can be very dangerous; thus, the American College of Physicians-American Society of Internal Medicine End-of-Life Care Consensus Panel felt that general internists who wished to use methadone for their patients would be best advised to consult a pain team (such as that headed by Dr. Berland) for the most up-to-date information on the correct equianalgesic dosing.
Janet Abrahm, MD
Hospital of the University of Pennsylvania; Philadelphia, PA 19104
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
