This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in JAMA  Topic Collections  • Pain  • Osteoarthritis  • Alert me on articles by topic

	Since this article does not have an abstract, we have provided the first 138 words of the full text and any section headings.

To the Editor: Dr Lonner¹ did not discuss the use of opioids as treatment for the persistent, severe pain of osteoarthritis. Because of the advanced age of many patients with disabling osteoarthritis, they often have comorbid conditions that make opioids less risky than surgery. Moreover, some elderly patients may simply decline major interventions despite ongoing pain. Chronic opioid use may alleviate pain and improve function in selected patients.²

Many patients are not candidates for chronic opioid use, which has potential adverse effects that may be more prevalent in elderly persons. But the same can be said for other options that are discussed by Lonner, such as NSAIDs.

Most states now have regulations or laws governing the use of chronic opioids for intractable pain. In addition, several specialty societies provide guidelines for opioid use.³

Barry Egener, MD
Portland, Ore

1. Lonner JH. A 57-year-old man with osteoarthritis of the knee. JAMA. 2003;289:1016-1025. FREE FULL TEXT 2. Roth SH, Fleischmann RM, Burch FX, et al. Around-the-clock, controlled-release oxycodone therapy for osteoarthritis-related pain: placebo-controlled trial and long-term evaluation. Arch Intern Med. 2000;160:853-860. FREE FULL TEXT 3. American Academy of Pain Medicine, American Pain Society. The Use of Opioids for the Treatment of Chronic Pain 1997. Available at: http://www.painmed.org/productpub/statements/pdfs/opioids.pdf. Accessibility verified May 28, 2003.

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290:36.

RELATED ARTICLES

Pain Management in Patients With Osteoarthritis
Thomas E. Finucane
JAMA. 2003;290(1):36.
EXTRACT | FULL TEXT  

Pain Management in Patients With Osteoarthritis—Reply
Jess H. Lonner
JAMA. 2003;290(1):36.
EXTRACT | FULL TEXT  

A 57-Year-Old Man With Osteoarthritis of the Knee
Jess H. Lonner
JAMA. 2003;289(8):1016-1025.
EXTRACT | FULL TEXT