A systematic review 1 including 26 RCTs with a total of 2 225 subjects was abstracted in DARE. In the 5 direct comparisons in post-operative pain, results were inconsistent. In all 3 direct comparisons in renal colic, intravenous NSAID had a faster onset of action than intramuscular or rectal. In 1 direct comparison in dysmenorrhoea, oral NSAID was better than rectal. In the 1 direct comparison in rheumatoid arthritis, intramuscular NSAID was better than oral. Adverse effects related to the route of administration were most often reported for intramuscular and rectal regimens.
Comment: The quality of evidence is downgraded by sparse data. The authors conclude that in pain conditions other than renal colic, there is a strong argument to give oral NSAIDs when patients can swallow.
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