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To the Editor: The duty to relieve symptoms, safely, is a preeminent one of health care professionals. We appreciate the concerns of Chandok and Watt1 about the need for cautious use of opioids, particularly in patients with advanced liver disease. Indeed, we concur that caution should be exercised by all health care experts in use of therapeutics. However, we have concerns with the recommendations by Chandok and Watt1 regarding opioid use. Although the fear of precipitating encephalopathy or causing excessive sedation is real, an equally cogent concern is that this fear may result in less-experienced practitioners thinking that pain must be experienced regardless, or that opioids are not safe to be used in patients with cirrhosis. Medically appropriate pain management to improve function and quality of life is acceptable for patients before they undergo transplant. 2-4 For those unsuitable for transplant (up to 85 …