Article Text

  1. N. Mehta,
  2. A. Gurbani,
  3. D. E. Fish
  1. Department of Orthopedics, David Geffen School of Medicine at UCLA, Los Angeles, CA


Background Up until recently, cyclooxygenase (COX)-2 selective agents were thought to have a significant advantage over conventional NSAIDs in terms of toxic effects, notably GI complications. For degenerative arthritis and various types of spine pain, COX-2 inhibitors had been frequently used as first-line therapy in the absence of any overt inflammation. This raises issues about both the appropriateness of prescribing coxibs and the rate of adverse events in low-dose short-term use in outpatient musculoskeletal clinics. Because pain relief in a multidisciplinary spine clinic can be challenging and had often been treated with many of the now off-market COX-2 selective agents, more data need to be gathered for the outcomes of those patients on low-dose therapy for pain relief.

Objective To determine the rate of adverse events for COX-2 selective agents when used in low doses for patients with various types of musculoskeletal pain.

Hypothesis We expect that patients will tolerate medications with minimal adverse events.

Methods/Design Of the 431 musculoskeletal spine pain patients in an outpatient clinic that were prescribed COX-2 selective agents, 220 were contacted and 55 successfully completed a self-assessment questionnaire.

Main Outcome Measure Pain relief and presence of adverse events: rash, CP/SOB, GI disturbances, etc.

Results 67% reported significant pain relief; 23.6% reported an adverse event during the period coinciding with COX-2 inhibitor use (Celebrex, Vioxx, Bextra, Mobic). Self-reported PMH: 25% hyperlipidemia, 47% hypertension (HTN), 18% heart disease, 18% GI disturbances, 11% gastric ulcers. Overall, 9% cited potential side effects as reason for discontinuing NSAID use. Of the 33% of patients reporting blood thinner use, 61% reported significant pain relief; 28% reported adverse events.

Conclusion In the small population (N = 55) evaluated, the pilot study finds minimum adverse events for all COX-2 selective agents when compared to reported literature rates of 31% (2000 CLASS study). Those with risk factors for potential adverse events did not report more events than those without risk factors while on COX-2 selective agents. The pilot study suggests that patients on low-dose COX-2 selective agents obtain pain relief with a low occurrence of adverse events and an even lower occurrence of serious adverse outcomes. More patient evaluations will be necessary to confirm the trends found in this pilot study.

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