Physical Medicine and Rehabilitation for Osteitis Pubis Medication

  • Author: Kelly L Allen, MD; Chief Editor: Consuelo T Lorenzo, MD   more...
 
Updated: Jun 22, 2010
 

Medication Summary

Nonsteroidal anti-inflammatory agents (NSAIDs) are the DOCs for treatment of osteitis pubis. Narcotics also are employed for pain control in some cases, usually in the obstetric or postsurgical patient. Limited case reports suggest that use of antibiotics and heparin also has been successful.

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Nonsteroidal anti-inflammatory drugs

Class Summary

Most commonly used for relief of mild to moderate pain. Although ibuprofen is the DOC for initial therapy, other options include, but are not limited to, ketoprofen and naproxen.

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Ibuprofen (Advil, Motrin, Midol, Nuprin)

 

DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

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Ketoprofen (Actron, Orudis, Oruvail)

 

For relief of mild to moderate pain and inflammation.

Small dosages initially are indicated in small and elderly patients and in those with renal or liver disease. Doses over 75 mg do not increase therapeutic effects. Administer high doses with caution and closely observe patient for response.

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Naproxen (Aleve, Naprelan, Naprosyn, Anaprox)

 

For relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing activity of cyclo-oxygenase, which results in a decrease of prostaglandin synthesis.

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Cyclooxygenase-2 (COX-2) inhibitors

Class Summary

Although increased cost can be a negative factor, the incidence of costly and potentially fatal GI bleeds is clearly less with COX-2 inhibitors than with traditional NSAIDs. Ongoing analysis of cost avoidance of GI bleeds will further define the populations that will find COX-2 inhibitors the most beneficial.

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Celecoxib (Celebrex)

 

Inhibits primarily COX-2. COX-2 is considered an inducible isoenzyme, induced during pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited thus GI toxicity may be decreased. Seek lowest dose of celecoxib for each patient.

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Contributor Information and Disclosures
Author

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Coauthor(s)

Guy W Fried, MD  Assistant Professor, Department of Rehabilitation Medicine, Thomas Jefferson University; Outpatient Medical Director, Medical Director of Incontinence and Respiratory Care Programs, Magee Rehabilitation Hospital

Guy W Fried, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Everett C Hills, MD, MS  Vice Chair, Department of Physical Medicine and Rehabilitation, Medical Director for Outpatient Services, Penn State Hershey Rehabilitation Hospital, Assistant Professor of Physical Medicine and Rehabilitation, Assistant Professor of Orthopaedics and Rehabilitation, Penn State Milton S Hershey Medical Center and Penn State University College of Medicine

Everett C Hills, MD, MS is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Congress of Rehabilitation Medicine, American Medical Association, American Society of Neurorehabilitation, Association of Academic Physiatrists, and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Michael T Andary, MD, MS  Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD  Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health, Immanuel Rehabilitation Center

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

References

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Radiograph in a 19-year-old athlete who presented with a 3-week history of a groin pull that was not resolving. This radiograph shows the classic sclerosis and lysis findings of osteitis pubis around the pubis symphysis, with widening of the symphysis.
Pelvis, frontal view.
Magnetic resonance imaging (MRI) scan from a 20-year-old National Hockey League (NHL) player who presented with a complaint of testicle pain, which became worse with skating and with the performance of off-ice plyometric conditioning. The MRI scan of the player's pelvis, combined with the patient's history and physical examination, indicated a diagnosis of osteitis pubis.
 
 
 
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