Piroxicam versus naproxen in the treatment of acute musculoskeletal disorders in athletes

Abstract

Safe and effective therapy for acute musculoskeletal disorders would be extremely useful for competitive athletes. These injuries are common in these patients, who are usually highly motivated to return to their previous level of activity and performance. Because nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to be useful in inflammation-associated conditions such as rheumatoid arthritis and osteoarthritis, it was believed that their use in competitive athletes may be warranted. This study compared the efficacy and tolerability of two NSAIDs, piroxicam and naproxen, in these patients. The patients included 34 men and women who had acute symptoms including restrictions of movement and limitation of physical activity as a result of sprains to the ankle, acromioclavicular joint, and interphalangeal joint of the hand or acute soft-tissue injury to the shoulder, knee, or about the hip. In a double-blind, comparative, parallel manner, patients were randomly allocated to receive piroxicam 40 mg daily for two days and then 20 mg once daily, or naproxen 500 mg twice daily for two days, then 375 mg twice daily. Both drugs improved virtually all measures of physical discomfort after three and seven days of treatment (p less than 0.0001). Three days after beginning the study, the mean reduction in spontaneous pain, swelling, and tenderness was statistically superior in the piroxicam group (p less than 0.05) compared with the naproxen group. After seven days of treatment, a marginally larger reduction in swelling was associated with piroxicam (p = 0.081); however, no other statistically significant difference was seen. Although improvements in physical movement and strength were assessed, no consistent conclusion could be reached because of the small sample size; no statistically significant differences were seen between the treatment groups with respect to such improvements. Patient and investigator assessments of efficacy and tolerability were primarily excellent or good for both drugs. It was concluded that piroxicam and naproxen are effective and well-tolerated short-term treatments for acute musculoskeletal injuries in athletes.