Featured Review: Topical NSAIDs for acute musculoskeletal pain in adults

Evidence shows that gels, creams, and sprays are effective in providing pain relief and identifies which one works best.

Acute musculoskeletal pain describes conditions like a sprained ankle or a muscle pull. These usually get better over two or three weeks without treatment, but can be very painful while they last. Topical non-steroidal anti-inflammatory drugs (NSAIDs) are applied to skin where it hurts in the form of gels, creams, sprays, or plasters. Topical NSAIDs penetrate the skin, enter tissues or joints, and reduce processes causing pain in the tissue. Drug levels in the blood with topical NSAIDs are much lower than with the same drug taken by mouth, which minimizes the risk of harmful effects.

A team of Cochrane authors based in the United Kingdom worked with the Cochrane Pain, Palliative, and Supportive Care Review Group to determine the efficacy and safety of topically applied NSAIDs in acute musculoskeletal pain in adults. This review is an update of a review initially published in 2010.

The author team included 61 studies involving 8386 participants in this review. They rated included data as being of high quality. Topical NSAIDs provided good levels of pain relief in acute conditions such as sprains, strains, and overuse injuries, probably similar 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 usually minimal. The authors also identified 20 reports of completed or ongoing studies that had not been published in full, so could not be included.

“Since the last version of this review, the new included studies have provided additional information. In particular, information on topical diclofenac is greatly expanded. The present review supports the previous review in concluding that topical NSAIDs are effective in providing pain relief, and goes further to demonstrate that certain formulations, mainly gel formulations of diclofenac, ibuprofen, and ketoprofen, provide the best results.” said Sheena Derry, a Senior Research Officer at the University of Oxford in the United Kingdom and lead author of the Cochrane Review. “This Cochrane Review offers important news to patients and clinicians; out of the topical NSAID options, gel formulations work best and they are a safe alternative to oral drugs.”

Read the full Cochrane Review

Monday, June 15, 2015
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