Comparing Valdecoxib, Hydrocodone/acetaminophen, And Placebo In Relieving Golf-related Osteoarthritic Back Pain And Improving Swing Performance

Abstract

Introduction Data supports the efficacy of selective COX-2 inhibitors in chronic treatment of osteoarthritis (OA). However, the efficacy of a single dose for the acute or pre-emptive relief of back pain and restoration of function during the high demand sport of golf has not been documented. Purpose To provide data on the efficacy of the COX-2 inhibitor valdecoxib 10 mg (BextraTM) compared to hydrocodone/acetaminophen 5/500 mg (VicodinTM) and placebo in reducing or relieving acute back pain induced by the golf swing in patients with OA of the lumbar spine. This study also examined the effects of these agents on golf swing performance. Methods This randomized, double-blind, cross-over, 12 week study compared the effects of a single dose of valdecoxib (10 mg), hydrocodone/acetaminophen (5/500 mg), and placebo, on an initial baseline measurement of subjective pain (SF-36, Oswestry) and the biomechanical assessment of the golf swing as measured during simulated golf play. A drug wash-out period of ≥7–10 days was utilized between each treatment arm. Golf swing performance was measured via Motion Analysis (240 Hz, 37 markers, 15 segment body) with emphasis on hip and shoulder trunk rotations and peak club head velocity. Data between treatement arms were compared with a RMANOVA (p≤.05) with a Bonferroni adjustment for post-hocs. Results Valdecoxib and hydrocodone/acetaminophen were clinically equal to each other and statistically superior to placebo and baseline measures in improving baseline SF-36 and Oswestry scores. These drugs also promoted greater hip (p≤.05) and shoulder rotations (p≤.05) and increased club head speed (p≤.05) compared to placebo and baseline measures. Conclusion In senior golfers with low back OA, a pre-emptive dose of valdecoxib (10 mg) is as effective as the opioid analgesic, hydrocodone/acetaminophen (5/500 mg), in alleviating golf-induced low back pain and improving golf swing performance as measured by greater hip and shoulder rotations as well as club head speed.