Updated August 06, 2015.
Question: When Is a Toradol Injection Appropriate for Arthritis Patients?
Toradol (ketorolac tromethamine) is an injection which can be given to arthritis patients for pain relief. But, you will want to know more than that before agreeing to the injection.
When is a Toradol injection appropriate? If an arthritis patient is already on an oral nonsteroidal anti-inflammatory drug (NSAID), is it safe to inject Toradol?
How long is pain relief expected to last following an injection of Toradol? Is a Toradol injection ever given in combination with Kenalog? Is Toradol used for both rheumatoid arthritis and osteoarthritis?
Answer:
Indications for Toradol
Toradol (ketorolac tromethamine) is a nonsteroidal anti-inflammatory drug most often given by injection. It is indicated for short-term management of moderate to severe acute pain. It may be given for up to 5 days in adults.
Risks Associated With Toradol
Toradol is a potent NSAID and is associated with many risks. The risks associated with Toradol include, but are not limited to:
- bleeding, including bleeding ulcers
- renal (kidney) impairment
- allergic reactions, which can be life-threatening
According to rheumatologist Scott J. Zashin, MD, "Patients with risks for these problems probably should not receive the drug. It should be avoided in patients already on an oral NSAID (like ibuprofen or Mobic or naproxen) and is not typically given in combination with an injectable corticosteroid."
Dr. Zashin continued, "In fact, there may be an increased risk of bleeding ulcers when corticosteroids and NSAIDS are given simultaneously. The typical dose per injection of Toradol is 60 mg, but should be reduced to 30 mg for patients less than 110 lbs or greater than 64 years of age."
Toradol Is Helpful for Some But Not for Everyone
Toradol is indicated for patients who are unable to tolerate oral medications -- for example, during a post-surgical phase. The drug should not be used for minor or chronic painful conditions. Toradol is only to be used short term for severe pain.
Note from writer Carol Eustice: Toradol became more well-known a few years ago when it was revealed in an ESPN report that the drug is a "regular" in the locker rooms of the National Football League. It was referred to in the article (Nov. 28, 2011, "One Day, One Game" issue of ESPN The Magazine) as "beefed up Motrin", which when referred to that way seems innocent enough. Fact is, trainers were steered towards Toradol to control pain and keep their star players playing -- and away from steroid injections which have known side effects. Long-term effects of Toradol injections are not really known, however. And, since Toradol so effectively masks pain, is it doing more harm than good by letting athletes, or even non-athletes, perform above their current capability?
Answer provided by Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. Dr. Zashin is also an attending physician at Presbyterian Hospitals of Dallas and Plano. He is a fellow of the American College of Physicians and the American College of Rheumatology and a member of the American Medical Association. Dr. Zashin is author of Arthritis Without Pain - The Miracle of Anti-TNF Blockers and co-author of Natural Arthritis Treatment.