BMJ  2006;332:1452 (17 June), doi:10.1136/bmj.332.7555.1452

Letter

Life without COX 2 inhibitors

Opioids can be prescribed safely in osteoarthritis

The first 150 words of the full text of this article appear below.

EDITOR—In their editorial on life without COX 2 inhibitors Shaughnessy and Gordon give examples of drug and non-drug measures shown to be effective in osteoarthritis, but their discussion of opioids was not referenced.1 The omission of studies supporting the use of opioids was surprising, particularly when references for the non-drug measures were included even when the effect sizes were small or the data limited by small numbers.

Two systematic reviews of opioids in chronic non-cancer pain report several papers showing efficacy of opioids (morphine and oxycodone) in osteoarthritis, with an average reduction in pain intensity of 30%, generally considered to be clinically meaningful.2 3 While Kalso et al note the worries of addiction and drug diversion (presumably the reason they are referred to as "a last pharmacological resort" by Shaughnessy and Gordon) and caution that not all patients respond to opioids, Kalso noted in a BMJ editorial in 2005 . . . [Full text of this article]

Colette M Reid, specialist registrar in palliative medicine

Department of Palliative Medicine, Bristol Haematology and Oncology Centre, Bristol BS2 8ED colette.reid@bristol.ac.uk

Jeremy Horwood, research associate

MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Canynge Hall, Bristol BS8 2PR


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Relevant Article

Life without COX 2 inhibitors
Allen F Shaughnessy and Andrea E Gordon
BMJ 2006 332: 1287-1288. [Extract] [Full Text] [PDF]

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