Topical NSAIDs might be a safer choice for elderly patients and others at risk for gastrointestinal adverse effects
Some formulations of topical non-steroidal anti-inflammatory drugs (NSAIDs) are as effective as oral NSAIDs at providing relief from the pain associated with arthritis in the knees or hands.finds a new review by The Cochrane Library.
A team of reviewers evaluated 34 studies involving 7,688 adults with chronic musculoskeletal pain for a period of at least 3 months. Participants were organized into groups using either a topical NSAID applied at least once daily, such as diclofenac, ketoprofen, indomethacin, and ibuprofen; a placebo; or an oral NSAID.
The reviewers found the topical NSAID diclofenac was as effective as oral NSAIDs for arthritis in the knee or hand and it gave more participants good pain relief compared to the placebo in studies lasting 8-12 weeks. In four studies, for example, diclofenac gave 60 percent of participants' pain relief over 8-12 weeks compared to 50 percent of those in the placebo group.
Lead reviewer Sheena Derry, Ph.D., of the Pain Research and Nuffield Department of Clinical Neurosciences at the University of Oxford in the U.K., explained, however, that the use of topical formulations is limited to conditions where the pain is "near to the surface."
Topical NSAIDs can be applied directly to the painful joint and do not cause gastrointestinal distress.
"The benefit of topical over oral NSAIDs is that with topical, the drug stays close to the site of application, so levels in blood and more remote tissues remain very low," said Derry. "This means you don't get the gastrointestinal problems that are associated and cause so many problems with oral NSAIDs."
The above story is reprinted from materials provided by Health Behavior News Service, part of the Center for Advancing Health.
The research has been published online September 12, 2012 in the Cochrane Database of Systematic Reviews:
Sheena Derry, R Andrew Moore, Roy Rabbie. Topical NSAIDs for chronic musculoskeletal pain in adults. Cochrane Database of Syst Rev, 2012, Issue 9 DOI: 10.1002/14651858.CD007400.pub2