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[Correspondence] Titrated doses are optimal for opioids in pain trials

We read with interest the study by Sameer Pathan and colleagues (May 14, p 1999),1 which compared the non-steroidal anti-inflammatory drug (NSAID) diclofenac, intravenous morphine (0·1 mg/kg), and paracetamol in patients with renal colic. The investigators concluded that diclofenac offered the most effective analgesia. However, the way that opioids were administered was far from optimal and created a clear disadvantage in the morphine group, which precludes any definite conclusion. The choice of the appropriate dose of NSAID is simple because there is a ceiling effect; lower doses are recognised to be as efficient as higher doses.