section name header

Evidence summaries

Topical Nsaids for Chronic Musculoskeletal Pain in Adults

Topical diclofenac and ketoprofen solutions reduce pain better than placebo and equivalent to oral NSAIDs in osteoarthritis with fewer gastrointestinal events but diclofenac may cause skin irritation in some patients. At least some of the substantial placebo effects seen in longer duration studies derive from effects imparted by the NSAID carrier itself. Level of evidence: "A"

Topical NSAIDs are recommended before starting oral NSAIDs for patients with osteoarthritis.

Rationale: The recommendation attaches a relatively high value for avoiding adverse effects of oral NSAIDs. Resources: Topical NSAIDs are relatively cheap.

Summary

Summary of findings: Topical diclofenac topical diclofenachttp://app.magicapp.org/widget/pico/index.html?openOnLoad=1&gId=anB09j&picoId=E548Wn

A Cochrane review [Abstract] 1 included 39 studies with a total of 10 631 subjects. All studies examined topical NSAIDs for treatment of osteoarthritis, 33 studies compared a topical NSAID with carrier.In studies lasting 6 to 12 weeks topical diclofenac and topical ketoprofen were significantly more effective than carrier for reducing pain; about 60% of participants had much reduced pain. With topical diclofenac, the NNT for clinical success in six trials (2343 participants) was 9.8 (95% CI 7.1 to 16). With topical ketoprofen, the NNT for clinical success in four trials (2573 participants) was 6.9 (5.4 to 9.3). There was too little information for analysis of other individual topical NSAIDs compared with carrier. Few trials compared a topical NSAID to an oral NSAID, but overall they showed similar efficacy. These efficacy results were almost completely derived from people with knee osteoarthritis.There was an increase in local adverse events (mostly mild skin reactions) with topical diclofenac compared with carrier or oral NSAIDs, but no increase with topical ketoprofen. Reporting of systemic adverse events (such as gastrointestinal upsets) was poor, but where reported there was no difference between topical NSAID and carrier. Clinical success with carrier occurred commonly - in around half the participants in studies lasting 6 to 12 weeks. Both direct and indirect comparison of clinical success with oral placebo indicates that response rates with carrier (topical placebo) are about twice those seen with oral placebo.

Clinical comments

Note

Date of latest search:

    References

    • Derry S, Conaghan P, Da Silva JA et al. Topical NSAIDs for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev 2016;4():CD007400. [PubMed]

Primary/Secondary Keywords