Drs. Tolle and Bascom raise some important points, with which we generally agree. We have no reason to believe that Alzheimer disease reduces the pain of osteoarthritis, spinal stenosis, or any other condition in the elderly, and it certainly can increase the likelihood of several pain-producing conditions ranging from fecal impaction and urinary retention to decubitus ulcers. Furthermore, just as dementia does not blunt pain, sedatives and tranquilizers do not adequately treat pain. Closer attention to the underlying cause of "agitation" in the elderly often reveals that its cause is untreated pain, for which an analgesic is likely to be more effective than haloperidol. Although overtreatment with some drugs, such as antipsychotic agents, has long been recognized in nursing homes, problems with underuse of other drugs, such as analgesics, are also common. In fact, for these two examples, the problems might often be interrelated. Although the proper role of opioids in managing chronic pain remains controversial, these drugs do have an important place, as do the often neglected nondrug approaches to pain relief.