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Evidence summaries

Non-Steroidal Anti-Inflammatory Drugs (Nsaids) for Treating Lateral Elbow Pain

Non-steroidal anti-inflammatory drugs may have some effect administered either topically or orally for lateral elbow pain, though at the cost of gastrointestinal side-effects with oral NSAIDs. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 14 studies. The median follow up was 2 weeks (range 1-12 weeks). Topical NSAIDs were more effective than placebo with respect to pain (WMD= -1.88, (95% CI -2.54 to -1.21) and participant satisfaction (RR 0.39, 95% CI 0.23 to 0.66) in the short term. Only two included trials assessed the effect of oral NSAID and these were not able to be pooled. There is some evidence for short term benefit with respect to pain and function from oral NSAIDs, but this benefit was not sustained. Significantly more gastrointestinal adverse effects were reported by those taking oral NSAIDs (RR 3.17, 95% CI 1.35 to 7.41).

In the short term there may be some advantage in steroid injection over oral NSAID (patient's perception of benefit, RR 3.06, (95% CI 1.55 to 6.06)], but this was not sustained in the longer term.

Comment: The quality of evidence concerning topical NSAIDs is downgraded by study quality (inadequate intention-to-treat adherence and lack of blinding) and by imprecise results (limited study size for each comparison) but upgraded by clear effect on pain.

References

  • Green S, Buchbinder R, Barnsley L, Hall S, White M, Smidt N, Assendelft W.. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst Rev. 2001;(4):CD003686.

Primary/Secondary Keywords