Unconditional tests for comparing two ordered multinomials

We consider two exact unconditional procedures to test the difference between two multinomials with ordered categorical data. Exact unconditional procedures are compared to other approaches based on the Wilcoxon mid-rank test and the proportional odds model. We use a real example from an arthritis pain study to illustrate the various test procedures and provide an extensive numerical study to compare procedures with regards to type I error rates and power under the unconditional framework. The exact unconditional procedure based on estimation followed by maximization is generally more powerful than other procedures, and is therefore recommended for use in practice.