Life without COX 2 inhibitors:Opioids can be prescribed safely in osteoarthritis

doi:10.1136/bmj.332.7555.1452

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Colette M Reid, specialist registrar in palliative medicine (colette.reid@bristol.ac.uk),
Jeremy Horwood, research associate

Department of Palliative Medicine, Bristol Haematology and Oncology Centre, Bristol BS2 8ED
MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Canynge Hall, Bristol BS8 2PR

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 …