Randomized double-blind comparison of the analgesic efficacy of intramuscular ketorolac and oral indomethacin in the treatment of acute gouty arthritis.
OBJECTIVE
To compare the analgesic effect of IM ketorolac tromethamine with that of oral indomethacin in the treatment of acute gouty arthritis.


METHODS
Prospective, randomized, double-blind, controlled, parallel group clinical trial.


METHODS
Two urban emergency departments.


METHODS
Twenty consecutive patients who presented to the ED with acute gout.


METHODS
Each patient was randomly assigned to receive in the ED (1) 60 mg of IM ketorolac and oral placebo or (2) 50 mg of oral indomethacin and IM placebo. The patients rated the intensity of their pain on a Wong-Baker pain scale (which runs from 0 to 5) before treatment and 30, 60, 90, and 120 minutes after treatment. All the patients were discharged with instructions to take oral indomethacin and to complete pain score cards at home at 6, 12, and 24 hours.


RESULTS
The 10 patients in each group were similar with regard to age, sex, race, and initial mean pain score. After 2 hours, the mean pain scores (+/- SD) for the ketorolac group had decreased from 4.5 +/- .71 to 1.4 +/- 1.43 (P < .05), and the mean score for the indomethacin group had decreased from 4.4 +/- .70 to 1.5 +/- 1.18 (P < .05). The difference between the two groups was not significant. At 6 hours, there was some pain rebound in the ketorolac group.


CONCLUSIONS
IM ketorolac and oral indomethacin are similar in the relief of the pain of acute gouty arthritis in the ED.
D000284:Administration, Oral; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D015210:Arthritis, Gouty / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D006074:Gout Suppressants / Q000627:therapeutic use*; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use*; D007273:Injections, Intramuscular; D020911:Ketorolac Tromethamine; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D014046:Tolmetin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome; D014325:Tromethamine / Q000031:analogs & derivatives* / Q000627:therapeutic use
D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D006074:Gout Suppressants; D014325:Tromethamine; D020911:Ketorolac Tromethamine; D014046:Tolmetin; D007213:Indomethacin