Pubdate: Thu, 14 Mar 2002
Source: Newsday (NY)
Copyright: 2002 Newsday Inc.
Contact:  http://www.newsday.com/
Details: http://www.mapinc.org/media/308
Author: Lindsey Tanner, AP Medical Writer
Bookmark: http://www.mapinc.org/find?186 (Oxycontin)

OXYCONTIN RECOMMENDED FOR ARTHRITIS

CHICAGO -- New treatment guidelines for osteoarthritis recommend using a 
wide range of drugs, from Tylenol to the controversial painkiller 
OxyContin, depending on the severity of the pain.

The American Pain Society's endorsement of opiates and heavily promoted 
newer drugs like Vioxx and Celebrex is among the strongest yet from medical 
groups that deal with arthritis patients, said Ada Jacox, a nurse who 
chaired the guidelines committee.

According to the guidelines, acetaminophen, or Tylenol, is the first choice 
for mild pain. Drugs like Vioxx and Celebrex -- known as cox-2 inhibitors 
- -- are best for patients with joint inflammation or moderate to severe 
pain. And opiates including morphine and oxycodone, the active ingredient 
in OxyContin, should be used for severe pain that does not respond to other 
drugs or treatments.

The society said the guidelines -- its first for arthritis -- are based on 
studies showing that cox-2 drugs work as well as other nonsteroidal 
anti-inflammatory drugs, including ibuprofen, but with less risk of stomach 
irritation.

OxyContin has been blamed in highly publicized overdose deaths linked to 
recreational use, but Jacox said the doses often needed to reduce severe 
arthritis pain are small and unlikely to be addictive.

While opiates are usually associated with cancer treatment, pain can be 
just as severe for the 20 million U.S. patients with osteoarthritis, Jacox 
said.

Last year, the Drug Enforcement Administration and several medical groups 
said they favored potent painkillers such as OxyContin for patients with a 
legitimate need.

The guidelines were slated for release Friday in Baltimore at the society's 
annual meeting.

Arthritis treatment guidelines from the American College of Rheumatology do 
not favor cox-2 drugs over less expensive over-the-counter medications such 
as acetaminophen.

Dr. Thomas Schnitzer, a Northwestern University rheumatologist who helped 
write the American College of Rheumatology guidelines, said opiates "are 
fine if people don't respond adequately" to other drugs, but that applies 
to very few arthritis patients.

Dr. Gary Kaplan, medical adviser to the Arthritis Foundation, said the 
foundation has guidelines similar to the pain society's, but he said 
first-choice treatment for moderate pain shouldn't be limited to cox-2 drugs.

Based in suburban Chicago, the American Pain Society represents 3,500 pain 
specialists, including doctors, nurses and pharmacists.
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