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

A Cochrane review [Abstract] 1 included 15 studies with 759 participants. Of eight trials that studied topical NSAIDs (301 participants), five compared topical NSAIDs with placebo, one compared manipulative therapy and topical NSAIDs with manipulative therapy alone, one compared leech therapy with topical NSAIDs and one compared two different topical NSAIDs. Of seven trials that investigated oral NSAIDs (437 participants), two compared oral NSAIDs with placebo, one compared oral NSAIDs and bandaging with bandaging alone, three compared oral NSAIDs with glucocorticoid injection, one compared oral NSAIDs with a vasodilator and two compared two different oral NSAIDs. No trials directly compared topical NSAIDs with oral NSAIDs. The median follow-up was 2 weeks (range 1 week to 1 year).

Topical NSAIDs were significantly more effective than placebo with respect to pain in the short term (MD -1.64, 95% CI -2.42 to -0.86, three trials 153 participants) and number needed to treat to benefit (7 (95% CI 3 to 21) on a 0 to 10 scale). One trial (85 participants) indicated that significantly more participants reported fair, good or excellent effectiveness with topical NSAIDs versus placebo at 28 days (14 days of therapy) (RR 1.49, 95% CI 1.04 to 2.14). No participants withdrew as the result of adverse events, but some studies reported mild adverse effects such as rash in 2.5% of those exposed to topical NSAIDs compared with 1.3% of those exposed to placebo.

One trial of oral NSAIDS found significantly greater improvement in pain compared with placebo, and the other trial found no between-group differences; neither trial found differences in function.

One trial regarding the comparative effects of oral NSAIDs and glucocorticoid injection reported a significant improvement in pain with glucocorticoid injection, and another found no between-group differences; treatment success was similar between groups (RR of fair, good or excellent effectiveness 0.74; 95% CI 0.43 to 1.26). Transient pain may occur following injection.

Comment: The quality of evidence is downgraded by limitations in study quality.

The following decision support rules contain links to this evidence summary:

• Topical NSAIDs for lateral epicondylitis http://www.ebmeds.org/ebmeds/ebmeds_home.asp?mode=scripts&submode=view&id=scr00604&country=UK

References

• Pattanittum P, Turner T, Green S et al. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst Rev 2013;5():CD003686. [PubMed].