Cyclooxygenase-2 inhibitor for pain management in osteoid osteoma

Thirteen patients with osteoid osteoma were enrolled in a prospective trial to test whether rofecoxib, a selective cyclooxygenase-2 inhibitor, is as e ffective for pain control as acetylsalicylic acid. Each patient documented the pain level using a visual analog scale, with 0 being no pain and 10 bei ng unbearable pain, during 2 days of no pain medication, 4 days of 500 mg a cetylsalicylic acid three times a day, and 10 days of 25 mg rofecoxib once a day. Oral administration of 500 mg acetylsalicylic acid three times a day led to a significant decrease in pain at night, pain at rest, and pain ind uced by exercise. Twenty-five milligrams rofecoxib given once a day at midd ay showed the same remarkable improvement in pain at night, pain at rest, a nd pain induced by exercise. Rofecoxib in comparison with acetylsalicylic a cid showed a trend toward lower pain levels in all categories. Rofecoxib of fered a significantly better reduction in pain at rest during the day than did acetylsalicylic acid. Results of the current study suggest that pain in duction in osteoid osteoma is related to cyclooxygenase-2, an enzyme that i s blocked by acetylsalicylic acid and rofecoxib. Conservative medical treat ment with rofecoxib for osteoid osteoma is recommended when percutaneous in tervention is associated with significant morbidity.