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Two nonsteroidal anti-inflammatory drugs, diflunisal and naproxen, were compared for efficacy in relieving anterior knee pain of mild to moderate severity. Of 36 patients completing the study, 20 received diflunisal and 16 received naproxen. Eleven (55%) patients given diflunisal and ten (63%) given naproxen had significant relief of pain, but there were no statistically significant differences between the two treatments. Although adverse reactions were frequent in both groups, they were not severe and they abated upon discontinuation of medication.

Effective pain relief and patient tolerance and acceptance are essential in outpatient management of mild to moderate pain of acute low back strain. This study evaluated the efficacy, tolerability, and acceptability of diflunisal and acetaminophen with codeine in patients with mild to moderate pain after an initial or recurrent acute low back strain. Both drugs demonstrated equipotent analgesic efficacy; however, diflunisal was superior to acetaminophen with codeine for patient tolerability and acceptability. The results demonstrated that the study drugs were effective in treating mild to moderate pain caused by acute low back strain in an ambulatory care setting.

An open, randomized clinical study was performed to evaluate the efficacy of diflunisal versus acetaminophen with codeine in patients who underwent outpatient arthroscopy of the knee. Twenty patients were randomly assigned to each treatment group. Nineteen patients in each group successfully completed the study, which consisted of both objective and subjective evaluations. The results showed equal efficacy between the two drugs. However, a larger percentage of patients viewed diflunisal as providing good to excellent results overall compared with acetaminophen with codeine.

An open-label comparison of diflunisal, a nonacetylated salicylate nonsteroidal anti-inflammatory drug (NSAID), and piroxicam, an NSAID belonging to the oxicam family, was conducted in patients with osteoarthritis. Efficacy assessments were made biweekly by the physician and patients during a 12-week treatment and observation period. The physician's evaluations showed that both drugs resulted in significant reductions in knee pain, tenderness, swelling, stiffness, and difficulty walking. A greater number of statistically significant differences were noted with diflunisal than with piroxicam, but there were no statistically significant differences between the two treatment groups. Patients' efficacy ratings tended to favor diflunisal, and diflunisal was significantly more effective than piroxicam in relieving night pain. Seventy-five percent of patients receiving diflunisal and 40% of those receiving piroxicam considered their condition improved after treatment; however, the proportion of good to excellent drug ratings was similar for the two drugs. Both drugs were generally well tolerated. Adverse effects were encountered in five (28%) of 18 patients given diflunisal and in four (33%) of 12 patients given piroxicam. Six patients were withdrawn from the study because of side effects, four from the piroxicam group and two from the diflunisal group. In this study, diflunisal was found to be an effective and well tolerated drug for use in the management of osteoarthritis.

Patients with osteoarthritis make up the largest group of users of nonsteroidal anti-inflammatory drugs (NSAIDs), but the effects of these agents on the gastrointestinal mucosa of such patients have not been well studied. This article describes a short-term comparison of two widely used NSAIDs, diflunisal and ibuprofen, in patients requiring these medications for their osteoarthritis. Efficacy, tolerability, and endoscopically documented effects of these drugs on the gastric and duodenal mucosa were assessed. Consenting, eligible patients were randomly assigned to one of the two study drugs for a two-week course. Clinical assessments were made after each week of treatment. Fiberoptic endoscopy and laboratory tests were performed before and after the treatment period. Thirty patients completed the study: 16 received diflunisal and 14 received ibuprofen. Similar improvements in pain, joint mobility, functional capacity, and joint swelling and tenderness were observed in both treatment groups. Transient, mild abdominal cramping was reported by two patients in each group; one patient receiving ibuprofen complained of transient dizziness. No patient withdrew from the study because of side effects. Follow-up endoscopy revealed slight (grade 1) changes in the gastric mucosa of two patients in each treatment group. An additional patient in the ibuprofen group had gastric erosions (grade 2) at the end of the study. Endoscopic changes were not correlated with symptoms. Diflunisal and ibuprofen were found to be similarly effective and well tolerated in the treatment of osteoarthritis. Their use may be associated with some gastrointestinal side effects even during short-term use.

Fifty college athletes with acute sprains and strains from football-related activities were randomly assigned to treatment with either diflunisal or acetaminophen with codeine for seven days. Additional treatment in both groups included rest, elevation, local application of cold or heat, splinting, and physical therapy, as indicated. Both treatment groups exhibited clinically significant improvements in pain, tenderness, and swelling. The results of this study show that diflunisal, a peripherally acting nonnarcotic nonsteroidal anti-inflammatory agent with analgesic properties, was as effective as acetaminophen with codeine in relieving mild to moderate pain due to musculo-skeletal sprains and strains. The long duration of action of diflunisal permits less frequent dosing, an important consideration when prescribing medication for active young adults.

The efficacy and tolerability of diflunisal (500 mg orally, twice daily) and piroxicam (20 mg orally, once daily) were compared in a 12-week open-label study in 44 patients with active rheumatoid arthritis. Both medications were equally effective and generally well tolerated. No significant differences were found between drug groups. Both groups showed statistically significant improvement in the overall number of swollen and tender joints, painful joint count, and the patients' assessment of pain and disease severity. Two (9%) of 23 patients in the diflunisal group and one (5%) of 21 patients in the piroxicam group reported adverse effects. Only one patient withdrew from the study because of side effects (lightheadedness during use of diflunisal). It is concluded that both diflunisal and piroxicam are highly effective and generally well tolerated in the management of rheumatoid arthritis.

Diflunisal (500 mg orally, twice daily) and naproxen (375 mg orally, twice daily) were compared for efficacy and tolerability in a 12-week open-label study in 33 patients with active rheumatoid arthritis (RA). Both drugs resulted in marked reduction in the number of swollen, tender, and painful joints and comparable improvement in patients' assessment of disease activity and pain. There were no significant differences between the two medications in the measured indices of disease activity. No adverse experiences were reported by patients in either treatment group. The results indicate that both diflunisal and naproxen were equally effective and that both agents are generally well tolerated in this group of patients with RA.

The authors favor conservative treatment of tennis elbow, starting with cessation of the offending activity and prescription of a nonsteroidal anti-inflammatory drug (NSAID) and followed by isometric and isotonic exercises when pain and inflammation have subsided. Two NSAIDs, diflunisal and naproxen, were evaluated in 38 patients with mild-to-moderate pain associated with tennis elbow. The physicians' assessments found no statistically significant differences between the two drugs; both provided effective reduction of pain and swelling. Patients' assessments of pain relief achieved with their respective drugs significantly (P = 0.019) favored diflunisal. Prompt and effective relief of pain and swelling hastens the patient's progression to physical therapy and return to normal activities.

Diflunisal, a nonacetylated salicylate preparation with a prolonged duration of action, was compared with ibuprofen for the treatment of rheumatoid arthritis in a multicenter trial comprising 210 patients. Diflunisal was administered twice a day (500 to 750 mg/day) and ibuprofen was administered four times a day (1,600 to 2,400 mg/day). To maintain double-blind conditions, all patients ostensibly followed the same regimen, ingesting their assigned drug and a matching placebo of their nonassigned drug. Disease activity assessments and laboratory tests were done periodically throughout the 12 weeks of the study, and results were compared with pretreatment findings. Efficacy evaluations in 187 patients showed that both treatments were similarly efficacious. Safety and tolerability also were similar in the two groups. Diflunisal, however, offers a more acceptable BID treatment schedule.

The emergency physician treats many patients with mild to moderate pain due to musculoskeletal injury. The physician must consider the extent of injury, the patient's medication history, and the potential for abuse when prescribing an oral analgesic. A study was designed to compare the efficacy of two oral analgesics, one containing a narcotic and one nonnarcotic, in relieving mild to moderate pain associated with grade 2 ankle sprain. Forty patients were enrolled--all with moderate pain--and were randomly allocated to treatment with either diflunisal or acetaminophen with codeine. Both analgesic agents were equally effective in relieving the pain. Side effects were experienced by six patients, all of whom were receiving acetaminophen with codeine; none of the patients given diflunisal noted side effects. Global assessments of the efficacy and tolerability of the study drugs showed that 89% of 19 patients given diflunisal and 43% of 21 patients given acetaminophen with codeine considered their respective analgesics excellent or very good.

We conducted an open-label randomized clinical trial comparing the efficacy and tolerability of diflunisal and dextropropoxyphene napsylate with acetaminophen (DPN-A) in the management of mild to moderate pain following arthroscopic surgery of the knee. Patients used a self-rating pain scale to evaluate the analgesia provided by each medication. Twenty-six patients completed the study; 12 received diflunisal and 14 received DPN-A. The physicians found no significant differences between the two groups in their preoperative or postoperative assessment of pain, tenderness, swelling, and active range of motion. There were no statistically significant differences between the two groups' mean pain scores or assessment of the overall efficacy of their respective drugs. No patient in either treatment group reported any adverse effects.

Thirty-one patients with osteoarthritis of the knee were treated with either diflunisal (n = 17) or naproxen (n = 14) in a 12-week open-label study. Treatment was begun with 500 mg BID of diflunisal or 375 mg BID of naproxen. Patients not showing an adequate response to these dosages were given increases to 750 mg BID of diflunisal (n = 7) or 500 mg BID of naproxen (n = 8). Both drugs achieved statistically significant improvements in pain indices, tenderness, swelling, morning stiffness, functional capacity, knee flexion, and 50-foot walking time, and no significant difference was found between the two drugs. At the end of the study, all patients taking diflunisal and 11/14 patients taking naproxen felt that they had improved with treatment. Drug safety and tolerability were assessed in 21 patients given diflunisal and 16 given naproxen (including patients not part of the efficacy evaluation). Six (29%) patients in the diflunisal group and four (25%) in the naproxen group experienced side effects; three were withdrawn from the diflunisal group and one from the naproxen group because of adverse effects. In general, both drugs were well tolerated.

The efficacy and safety of diflunisal versus placebo in the treatment of pain were compared in a multicenter, double-blind study of 1,037 patients treated for seven days by general practitioners. A statistically significant (P less than 0.001) difference in favor of diflunisal was seen using four evaLuation criteria. The incidence of side effects was generally low with both treatments; nevertheless, the number of patients suffering at least one side effect was greater after diflunisal than after placebo (P less than 0.05). A comparison of the profile of responders to diflunisal and to placebo showed no particular pattern.

A multicenter, open-label clinical trial evaluated the efficacy and tolerability of diflunisal given twice daily and aspirin given four times daily in the long-term treatment of patients with rheumatoid arthritis. Patients who successfully completed a 12-week, double-blind, parallel study comparing diflunisal (500 to 750 mg daily) with aspirin (2.6 to 3.9 gm daily) continued on the same medication in a 40-week, open-label segment of the study. The dosage of diflunisal could be increased to a maximum of 1 gm daily during the open-label phase. Both regimens were effective during the 40-week study. Diflunisal was better tolerated than aspirin as judged by the overall incidence of clinical adverse experiences. Patients treated with diflunisal had significantly fewer adverse experiences involving the digestive system and organs of special sense than did those treated with aspirin.

One hundred seventy-nine patients with asymptomatic or mildly symptomatic endodontic disease had single-visit therapy and were given either diflunisal (n = 94) or aspirin with codeine (n = 85) to control posttreatment pain. In this open-label, randomized study, diflunisal was judged superior to the aspirin-codeine combination in all major categories evaluated. Of patients receiving diflunisal, 93.6% needed the medication for only one day. In contrast, 77.7% of patients receiving aspirin with codeine needed the medication for only one day. Almost 64% of patients receiving diflunisal needed only one dose, while 32.9% of patients using aspirin with codeine needed only one dose. Four or more doses were required by 5.3% of patients receiving diflunisal and by 23.5% of patients receiving the aspirin-codeine combination. In patients receiving diflunisal, 20.2% experienced side effects. In contrast, 29.4% of patients receiving aspirin with codeine reported side effects. Thirty-five percent of patients receiving diflunisal rated the analgesic as excellent; 5.3% rated it as fair or poor. In contrast, 12.9% of patients receiving aspirin with codeine rated the analgesic combination as excellent; another 12.9% rated it as fair or poor. Diflunisal was found to be generally effective and well-tolerated, and superior to aspirin with codeine in the management of pain from endodontic treatment.

Fifty-six patients entered into an open-label, randomized study to compare the efficacy and tolerability of diflunisal and naproxen in the treatment of mild to moderate pain associated with acute low back strain. Thirty-three patients completed the two-week study. No patients withdrew because of side effects, and both drugs were well tolerated. Results showed that diflunisal was more effective than naproxen (81% versus 41%) in relieving pain. Of the 16 patients taking diflunisal, 13 rated its efficacy as very good or excellent; six (35%) of 17 patients taking naproxen rated their drug similarly. Overall, diflunisal rated slightly better in efficacy and tolerability and in improving limitation of function and motion. In addition, diflunisal has a longer duration of action and thus requires less frequent dosing than naproxen.