Topical NSAIDs for acute musculoskeletal pain in adults.

摘要: Background Use of topical NSAIDs to treat acute musculoskeletal conditions has become widely accepted because they can provide pain relief without associated systemic adverse events. This review is an update 'Topical for in adults' originally published Issue 6, 2010. Objectives To determine the efficacy and safety topically applied adults. Search methods We searched Cochrane Register Studies Online, MEDLINE, EMBASE February 2015. We sought unpublished studies by asking personal contacts searching online clinical trial registers manufacturers websites. For earlier review, we also our own in-house database contacted manufacturers. Selection criteria We included randomised, double-blind, active or placebo (inert carrier)-controlled trials which treatments were administered adults with resulting from strains, sprains sports overuse-type injuries (twisted ankle, instance). There had be at least 10 participants each treatment arm, application once daily. Data collection analysis Two authors independently assessed inclusion, extracted data. used numbers achieving outcome calculate risk ratio needed additional beneficial (NNT) harmful (NNH) compared other treatment. reported 95% confidence intervals (CI). particularly interested compare different formulations (gel, cream, plaster) individual NSAIDs. Main results For this added 14 new (3489 participants), excluded four studies. identified 20 reports completed ongoing that have not been full. The 47 studies. This 61 Most form a gel, spray, cream similar placebo; 5311 treated NSAID, 3470 placebo, 220 oral NSAID. was 63% increase number over previous version review. registries unavailable results amounting about 5900 5300 events. Formulations diclofenac, ibuprofen, ketoprofen, piroxicam, indomethacin demonstrated significantly higher rates success (more 50% relief) than matching (moderate high quality data). Benzydamine did not. Three drug formulation combinations NNTs below 4. Emulgel® lowest NNT 1.8 (95% CI 1.5 2.1) two using intensity reduction as outcome. Diclofenac plasters Flector® low 3.2 (2.6 4.2) based on good excellent responses some Ketoprofen gel 2.5 (2.0 3.4), five 1980s, less well defined outcomes. Ibuprofen 3.9 (2.7 6.7) outcomes marked improvement complete remission. All values above 4, indicating lesser efficacy. There insufficient data reliably same NSAID. Local skin reactions generally mild transient, differ (high very few events data) withdrawals due (low data). Authors' conclusions Topical provided levels such sprains, strains overuse injuries, probably NSAIDs. Gel diclofenac (as Emugel®), patches, best effects. Adverse usually minimal. Since last information. In particular, information greatly expanded. present supports concluding are effective providing relief, goes further demonstrate certain formulations, mainly results. Large amounts identified, could influence updates