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The Effect of Tolmetin on the Chronic Pain and Decreased Functional Capacity Associated With Degenerative Joint Disease
Author(s) -
Amadio P.,
Cummings D.M.
Publication year - 1985
Publication title -
the journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.92
H-Index - 116
eISSN - 1552-4604
pISSN - 0091-2700
DOI - 10.1002/j.1552-4604.1985.tb02809.x
Subject(s) - placebo , medicine , joint pain , joint disease , range of motion , morning , morning stiffness , crossover study , anesthesia , chronic pain , physical therapy , osteoarthritis , disease , psoriatic arthritis , alternative medicine , pathology
Degenerative joint disease (DJD) is a common disorder characterized by chronic pain and limitation of activity, for which treatment with a nonsteroidal anti‐inflammatory drug (NSAID) is often useful. The anti‐inflammatory activity of the NSAID tolmetin sodium has been well described, being comparable in efficacy to indomethacin and effective for the relief of the acute and chronic symptoms that accompany DJD. To examine specifically the effect of tolmetin in controlling the pain and functional limitation in DJD of the spine, tolmetin was tested against placebo in a double‐blind, two‐segment, crossover study. Twenty‐six patients (mean age, 62.5 years; range, 42–79 years) received three weeks of tolmetin 1,200 mg/d and three weeks of placebo. The results showed that tolmetin provided significantly greater relief of symptoms than placebo in virtually all measurements of joint pain and stiffness: tenderness, pain at rest, pain on motion, intensity of joint pain ( P < 0.001), and duration of morning stiffness ( P = 0.002). Statistically significant improvement was noted in two of the three measures of cervical range of motion (P 0.01) and in all assessments of daily living activities (P = 0.001 in four parameters; P = 0.02 in a fifth parameter). Global evaluations of response to treatment by both patients and investigator also demonstrated significant effects ( P 0.002). Significantly more placebo patients (13 of 26) than tolmetin patients (two of 26) found the medication ineffective and discontinued treatment prematurely ( P = 0.01). No serious or limiting adverse reactions were seen during placebo or tolmetin therapy. The most frequently reported side effects on both therapies were gastrointestinal. Dermal and central nervous system adverse reactions were encountered only rarely. Side effects apparently related to the pharmacologic activity of NSAIDs on renal prostaglandins were seen in some tolmetin patients who experienced mild hypertension, edema, and weight gain. The study was effective in demonstrating a significant difference between active drug and placebo. Tolmetin provided safe and effective relief from the chronic pain and limited functional capacity associated with DJD of the spine .