Topical NSAIDs Effective for Chronic Musculoskeletal Pain

Equivalent to oral NSAIDs in efficacy but with fewer adverse gastrointestinal effects

THURSDAY, Sept. 27 (HealthDay News) -- Topical nonsteroidal anti-inflammatory drugs (NSAIDs) can provide effective pain relief for chronic musculoskeletal pain in adults, according to a review published online Sept. 12 in The Cochrane Library.

Sheena Derry, Ph.D., from the University of Oxford in the United Kingdom, and colleagues conducted a literature search to examine the use of topical NSAIDs in chronic musculoskeletal pain in studies of high methodological quality with duration of at least eight weeks. Randomized, double blind studies with placebo or active comparators that included at least 10 participants in each treatment arm were selected.

Among 7,688 participants in 34 studies, 23 studies compared a topical NSAID with placebo. The researchers found that, compared with placebo, topical NSAIDs were significantly more effective for reducing chronic musculoskeletal condition-related pain. In osteoarthritis, the numbers needed to treat for at least 50 percent pain relief over eight to 12 weeks was 6.4 for topical diclofenac solution and 11 for the gel formulation, compared with placebo. There was no difference in efficacy for a direct comparison of topical NSAID and oral NSAID. Compared to placebo or oral NSAIDs, there was an increase in local adverse events (mostly mild skin reactions) with topical NSAIDs but there was no increase in serious adverse events. There was no difference in gastrointestinal adverse events with topical NSAIDs and placebo, but they were less frequent than with oral NSAIDs.

"Topical NSAIDs can provide good levels of pain relief," the authors write. "Topical diclofenac solution is equivalent to that of oral NSAIDs in knee and hand osteoarthritis, but there is no evidence for other chronic painful conditions."

One author disclosed financial ties to the pharmaceutical industry.

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