Marcel Dvorak and Charles Fisher concurred that, in our update of the guideline on the management of chronic pain in patients with breast cancer, no mention was made of surgical stabilization techniques for the treatment of axial skeletal pain due to bone metastases. The guideline was intended to cover the spectrum of pain in women with breast cancer, particularly in common situations. We emphasized the importance of recognizing that pain exists and the appropriate use of pain medications. This latter point is important because of the chronic and frequent underuse of opiates and co-analgesics. We stated that neurosurgical interventions (and we would include spinal stabilization here) are rarely required. Careful identification of patients who potentially might benefit from surgery is important.
Mark L. Levine Department of Medicine McMaster University Hamilton Ont.