Randomized Double-Blind Comparison of the Analgesic Efficacy of Intramuscular Ketorolac and Oral Indomethacin in the Treatment of Acute Gouty Arthritis

Abstract

Study objective: To compare the analgesic effect of IM ketorolac tromethamine with that of oral indomethacin in the treatment of acute gouty arthritis. Design: Prospective, randomized, double-blind, controlled, parallel group clinical trial. Setting: Two urban emergency departments. Participants: Twenty consecutive patients who presented to the ED with acute gout. Interventions: 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. Conclusion: IM ketorolac and oral indomethacin are similar in the relief of the pain of acute gouty arthritis in the ED. [Shrestha M, Morgan DL, Moreden JM, Singh R, Nelson M, Hayes JE: Randomized double-blind comparison of the analgesic efficacy of intramuscular ketorolac and oral indomethacin in the treatment of acute gouty arthritis. Ann Emerg Med December 1995;26:682-686.]