Topical Nsaids for Acute Musculoskeletal Pain in Adults (Review)

Review

. 2015 Jun 11;2015(6):CD007402.

doi: 10.1002/14651858.CD007402.pub3.

Topical NSAIDs for acute musculoskeletal pain in adults

Affiliations

• PMID: 26068955
• PMCID: PMC6426435
• DOI: 10.1002/14651858.CD007402.pub3

Free PMC commodity

Review

Topical NSAIDs for acute musculoskeletal pain in adults

Sheena Derry  et al. Cochrane Database Syst Rev. 2015 .

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Abstract

Background: Use of topical NSAIDs to treat acute musculoskeletal weather condition has get widely accustomed considering they tin provide hurting relief without associated systemic adverse events. This review is an update of 'Topical NSAIDs for acute pain in adults' originally published in Issue half-dozen, 2010.

Objectives: To determine the efficacy and safety of topically practical NSAIDs in acute musculoskeletal pain in adults.

Search methods: We searched the Cochrane Register of Studies Online, MEDLINE, and EMBASE to February 2015. We sought unpublished studies by asking personal contacts and searching online clinical trial registers and manufacturers websites. For the earlier review, we as well searched our own in-house database and contacted manufacturers.

Selection criteria: We included randomised, double-blind, active or placebo (inert carrier)-controlled trials in which treatments were administered to adults with astute pain resulting from strains, sprains or sports or overuse-blazon injuries (twisted ankle, for instance). There had to be at to the lowest degree 10 participants in each handling arm, with awarding of handling at to the lowest degree once daily.

Data collection and analysis: Two review authors independently assessed studies for inclusion, and extracted data. We used numbers of participants achieving each effect to calculate the risk ratio and numbers needed to treat for an additional beneficial outcome (NNT) or additional harmful event (NNH) compared with placebo or other agile treatment. Nosotros reported 95% conviction intervals (CI). Nosotros were particularly interested to compare different formulations (gel, cream, plaster) of individual NSAIDs.

Main results: For this update we added 14 new included studies (3489 participants), and excluded four studies. We also identified 20 additional reports of completed or ongoing studies that have non been published in full. The earlier review included 47 studies.This update included 61 studies. Nigh compared topical NSAIDs in the grade of a gel, spray, or cream with a similar topical placebo; 5311 participants were treated with a topical NSAID, 3470 with placebo, and 220 with an oral NSAID. This was a 63% increase in the number of included participants over the previous version of this review. We also identified a number of studies in clinical trial registries with unavailable results amounting to about 5900 participants for efficacy and 5300 for adverse events.Formulations of topical diclofenac, ibuprofen, ketoprofen, piroxicam, and indomethacin demonstrated significantly college rates of clinical success (more participants with at least 50% pain relief) than matching topical placebo (moderate or high quality information). Benzydamine did non. Three drug and conception combinations had NNTs for clinical success below 4. For diclofenac, the Emulgel® formulation had the lowest NNT of 1.viii (95% CI ane.five to 2.1) in two studies using at least 50% pain intensity reduction equally the outcome. Diclofenac plasters other than Flector® besides had a depression NNT of 3.2 (2.6 to 4.2) based on proficient or excellent responses in some studies. Ketoprofen gel had an NNT of ii.five (2.0 to iii.4), from five studies in the 1980s, some with less well defined outcomes. Ibuprofen gel had an NNT of 3.9 (2.seven to vi.7) from ii studies with outcomes of marked comeback or complete remission. All other drug and formulation combinations had NNT values above 4, indicating lesser efficacy.There were insufficient data to compare reliably private topical NSAIDs with each other or the aforementioned oral NSAID.Local skin reactions were generally mild and transient, and did not differ from placebo (loftier quality data). There were very few systemic adverse events (high quality information) or withdrawals due to adverse events (low quality information).

Authors' conclusions: Topical NSAIDs provided skillful levels of hurting relief in astute conditions such as sprains, strains and overuse injuries, probably like to that provided by oral NSAIDs. Gel formulations of diclofenac (as Emugel®), ibuprofen, and ketoprofen, and some diclofenac patches, provided the best effects. Adverse events were unremarkably minimal.Since the concluding version of this review, the new included studies have provided boosted information. In particular, information on topical diclofenac is greatly expanded. The nowadays review supports the previous review in concluding that topical NSAIDs are constructive in providing hurting relief, and goes further to demonstrate that certain formulations, mainly gel formulations of diclofenac, ibuprofen, and ketoprofen, provide the all-time results. Large amounts of unpublished data take been identified, and this could influence results in updates of this review.

Conflict of involvement statement

SD has no conflicts relating to this review or any like production.

RAM has no conflicts relating to this review or whatsoever similar product.

PW has no conflicts relating to this review or whatever like product.

HG has no conflicts relating to this review or whatever like product.

MM has no conflicts relating to this review or any similar production.

Figures

Effigy 1

Study flow diagram.

Effigy 2

Take a chance of bias summary: review authors' judgements virtually each take chances of bias item for each included study.

Effigy iii

Methodological quality graph: review authors' judgements about each methodological quality item presented equally percentages across all included studies.

Figure 4

Forest plot of comparing: ii Individual NSAID versus placebo, upshot: 2.ane Clinical success.

Figure five

L'Abbé plot of clinical success in studies of topical diclofenac versus topical placebo. The size of the symbol is proportional to the size of the study (inset scale). Dark bluish: Emulgel; low-cal blue: spray/gel; ruby-red: Flector; pinkish: other patch or plaster.

Figure 6

L'Abbé plot of clinical success in studies of topical ketoprofen versus topical placebo. The size of the symbol is proportional to the size of the written report (inset scale). Calorie-free blue: ketoprofen gel; pink: ketoprofen plaster.

Assay one.i

Comparison 1 Private NSAID versus placebo, Outcome i Clinical success.

Assay 1.two

Comparison ane Private NSAID versus placebo, Outcome ii Local agin events.

Analysis 2.ane

Comparing ii Diclofenac versus placebo (effect of formulation), Outcome i Clinical success.

Analysis iii.ane

Comparison 3 Ibuprofen versus placebo (outcome of conception), Outcome ane Clinical success.

Analysis 4.1

Comparison 4 Ketoprofen versus placebo, Outcome i Clinical success.

Analysis 5.ane

Comparing 5 All topical NSAIDs versus placebo, Event i Local agin events.

Analysis 5.two

Comparison 5 All topical NSAIDs versus placebo, Outcome 2 Systemic adverse events.

Analysis 5.iii

Comparison v All topical NSAIDs versus placebo, Outcome 3 Adverse effect withdrawals.

Assay 6.1

Comparison vi Topical NSAID versus active comparator, Outcome 1 Clinical success ‐ topical piroxicam vs topical indomethacin.

Analysis 6.two

Comparison 6 Topical NSAID versus active comparator, Outcome 2 Local adverse events ‐ topical piroxicam vs topical indomethacin.

Update of

• Topical NSAIDs for astute pain in adults.

  Massey T, Derry S, Moore RA, McQuay HJ. Massey T, et al. Cochrane Database Syst Rev. 2010 Jun 16;(vi):CD007402. doi: x.1002/14651858.CD007402.pub2. Cochrane Database Syst Rev. 2010. PMID: 20556778 Free PMC article. Updated. Review.

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Source: https://pubmed.ncbi.nlm.nih.gov/26068955/

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