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.