Effectiveness of various non-steroidal anti-inflammatory drugs in pain management of patients with vertebral fracture: A comparative clinical study

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Purpose: To study the effectiveness of various nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with vertebral fractures.Methods: A total of 78 patients (17 males and 61 females) with a mean age of 69.5 years were included. The major inclusion criterion was an osteoporotic vertebral fracture between T7 and L3. The exclusion criteria included fractures above T7 and below L3; and other bone disorders such as disc herniation, spondylolisthesis, an infection, or a tumour. Pain intensity was assessed with the aid of a 10-point visual analogue scale (VAS). Bone mineral density (BMD) data, delay in reunion, and any other matter of significance, were discussed with the treating doctors and cross-checked with independent doctors. The NSAIDs given were non-selective cyclo-oxygenase (COX) inhibitors (naproxen, indomethacin and flurbiprofen) and selective COX 2 inhibitors (piroxicam, celecoxib, and rofecoxib). All data were compiled and appropriately analysed.Results: Some NSAIDs interfered with bone healing. No male required surgery, but two females taking naproxen, one taking flurbiprofen, and another taking celecoxib, required surgery. In terms of bone healing, non-union and delay in reunion were more evident in those taking naproxen, indomethacin or flurbiprofen than in those taking piroxicam, celecoxib, or rofecoxib. All T scores were lower than -2.5, indicating that all the patients were osteoporotic. Positive changes in T scores after 12 weeks were evident only in those taking rofecoxib, celecoxib, or piroxicam. VAS scores were also better in these patients.Conclusions: Celecoxib seems to be the best of the six NSAIDs in terms of both analgesia and bone health. The study recommends the use of celecoxib in patients with vertebral fractures.Keywords: Orthopaedic, NSAID, COX, Bone reunion, Analgesic activity, Pain management, T score

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