Treatment of pain in the elderly.

Sir: I would like to make a few comments on an article that appeared in the July 1980 issue of your Journal, 'Double-blind crossover trial of oral meptazinol, pentazocine and placebo in the treatment of pain in the elderly'. The authors state that the equi-analgesic dose of 100 mg of meptazinol is 60 mg of Talwin. The authors then compare 100 mg of meptazinol to 25 mg of Talwin, 1/2 the equi-analgesic dose, and say that meptazinol is a better analgesic than Talwin obviously an improper conclusion. It is interesting to note that even at 1/2 the equi-analgesic dose, Talwin 'gave significant pain relief at all times over the 4-hour period.' I would also like to point out that the incidence of side effects (nausea and vomiting) in meptazinol was three times that of pentazocine, according to the authors' own data. The authors also say that 'no patient was noticeably confused or obtunded at the doses used', confirming that pentazocine is clinically well tolerated in the elderly. This effect would be in agreement with many other investigators who have used pentazocine in the treatment of pain in the elderly with the results that show that the medicine is well tolerated and efficacious (Befeler and Giattini, 1970; Ende, 1965; Taylor, 1971).