A randomized clinical trial comparing ibuprofen to piroxicam for the relief of chronic non-rheumatic joint pain

Nonsteroidal antiinflammatory agents (NSAIDs) demonstrate similar efficacy for chronic joint pain, however they are not equally affordable. We assessed whether patients who preferred a more expensive NSAID, i.e. piroxicam, had better pain relief on this drug versus ibuprofen when they were blinded to the medications. We used a series of double-blinded, randomized, single subject trials. Twenty-six patients received either ibuprofen (800 mg TID) or piroxicam (20 mg QD with placebo BID) in opaque gelatin capsules for two three-week intervals. At the end of each treatment period we measured pain relief scores on a 0 to 100 scale (0 = no pain relief and 100 = total pain relief), patients' guess of medication given, side effects, overall status, and overall preference. Twenty patients successfully completed the trial. As a group, they had better pain relief on piroxicam compared to ibuprofen (p = 0.03). Patients guessed the correct medication in 67.5% of the treatment periods (lower one-sided 95% CI = 55%, p = 0.02); guesses were better in the second period (80% correct) but not influenced by whether they received ibuprofen or piroxicam in the first period (Z = -0.1, p = 0.46). Our pilot study showed that a clinically significant difference was + 15 units. Based on this criteria only 10 of 20 patients had clinically significant pain relief on piroxicam. The patient-defined clinically significant difference was + 30 units, and only 7 of 20 patients (35%) met this criteria. Side effects from the medications were not significantly different. Overall, patients preferred the treatment period in which they received piroxicam (14 patients) versus ibuprofen (7 patients). In patients with a strong preference for piroxicam, only half or less will have clinically significant pain relief on piroxicam compared to ibuprofen when administered the medication in a blinded fashion.

Duke Scholars

Author Rowena Joy Dolor Medicine, General Internal Medicine

Author David Lee Simel Medicine, General Internal Medicine