Oxycontin Recommended for Arthritis

By LINDSEY TANNER
.c The Associated Press


CHICAGO (AP) - 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.

On the Net:

APS: http://www.ampainsoc.org

American College of Rheumatology: http://www.rheumatology.org

Arthritis Foundation: http://www.arthritis.org

AP-NY-03-14-02 1956EST