Free
Letters to the Editor  |   May 2005
IM Ketorolac Versus OMT: Was Agent at Peak Analgesic Effect in JAOA Study?
Author Affiliations
  • Jeffrey L. Coston, DO
    American Board of Anesthesiology
 Department of Anesthesiology
 Park Ridge Hospital – Surgical Services
 Fletcher, North Carolina
    Diplomate
Article Information
Osteopathic Manipulative Treatment / Pain Management/Palliative Care
Letters to the Editor   |   May 2005
IM Ketorolac Versus OMT: Was Agent at Peak Analgesic Effect in JAOA Study?
The Journal of the American Osteopathic Association, May 2005, Vol. 105, 237-238. doi:
The Journal of the American Osteopathic Association, May 2005, Vol. 105, 237-238. doi:
To the Editor: Tamara M. McReynolds, DO, and Barry J. Sheridan, DO, have written a thoughtful article titled “Intramuscular Ketorolac Versus Osteopathic Manipulative Treatment in the Management of Acute Neck Pain the Emergency Department: A Randomized Clinical Trial” (2005; 105:57–68). I have one concern about their conclusion, however, that osteopathic manipulative treatment (OMT) is as efficacious as ketorolac tromethamine injected intramuscularly (IM) when treating this patient population. 
The authors have set the study's endpoint at one hour after treatment. However, official product information from Roche Pharmaceuticals, as noted in the 2005 edition of Physicians' Desk Reference,1 indicates that maximum efficacy of IM ketorolac is reached at two to three hours after administration. 
McReynolds and Sheridan conclude that IM ketorolac, 30 mg, and OMT are equally efficacious at one hour posttreatment. 
My question for the authors is as follows: Is OMT equally efficacious with IM ketorolac, 30 mg, when the agent is at its peak analgesic effect, that is at 2 to 3 hours after administration? To me, this is the more important question. 
I would suggest that comparison of the two treatment modalities at one, two, and four hours posttreatment would have made a good study even better. 
Chesanow N, Fleming H, eds. TORADOL (ketorolac tromethamine injection). Clinical Pharmacology. Physicians' Desk Reference. 2005. 59th ed. Montvale, NJ: Thompson PDR; 2005:2933 .