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Three Part Question

In [adults with acute musculoskeletal injury] is [diclofenac superior to ibuprofen] in [reducing pain]?

Clinical Scenario

A 24 year old man presents to the ED complaining of having injured his knee earlier that evening in a football match. He is in a significant amount of pain so you prescribe him diclofenac. A medical student asks why you prescribed diclofenac rather than ibuprofen, given its higher risk of gastro-intestinal complications. You inform the student that diclofenac is a better analgesic than ibuprofen but wonder if there is any evidence to support this.

Search Strategy

Medline 1996 to June Week 5 2010 via the OVID interface
[exp musculoskeletal system OR exp musculoskeletal diseases OR exp leg injuries OR exp wounds and injuries OR exp arm injuries] AND [ibuprofen ti.ab.sh AND diclofenac ti.ab.sh]
LIMIT to human AND English

Search Outcome

120 papers were identified, of which none were relevant.

Comment(s)

There is no literature reviewing the efficacy of diclofenac compared to ibuprofen.

Clinical Bottom Line

While NSAIDs are commonly used drugs in the ED, there is no literature to support the notion that diclofenac has superior analgesic qualities to ibuprofen. Local hospital/pharmacy guidelines should be followed pending research.