From the Research
Effectiveness of Topical NSAIDs for Musculoskeletal Pain
- Topical NSAIDs have been shown to be effective in relieving pain in acute and chronic painful musculoskeletal disorders, including osteoarthritis, tendonitis, and muscle strains 1.
- Studies have found that topical diclofenac and topical ketoprofen are significantly more effective than carrier for reducing pain in osteoarthritis, with about 60% of participants experiencing much reduced pain 2.
- The number needed to treat (NNT) for clinical success with topical diclofenac was 9.8 (95% confidence interval (CI) 7.1 to 16) and with topical ketoprofen was 6.9 (5.4 to 9.3) 2.
Comparison of Topical NSAIDs
- There is limited information available for analysis of other individual topical NSAIDs compared with carrier 2.
- Few trials have compared a topical NSAID to an oral NSAID, but overall they have shown similar efficacy (low quality evidence) 2.
- Topical diclofenac and topical ketoprofen have been found to provide good levels of pain relief beyond carrier in osteoarthritis for a minority of people, but there is no evidence for other chronic painful conditions 2.
Safety and Adverse Events
- Topical NSAIDs have been found to have a better safety profile than oral NSAIDs for single joint osteoarthritis and acute muscle injuries 1.
- Local adverse events, such as mild skin reactions, have been reported with topical diclofenac, but not with topical ketoprofen 2.
- Systemic adverse events, such as gastrointestinal upsets, have been poorly reported, but where reported, there was no difference between topical NSAID and carrier (very low quality evidence) 2.
Guidelines for Use
- Guidelines have been developed for the rational use of NSAIDs for musculoskeletal disorders, including the selection of specific NSAIDs and the minimization of dose and duration 3, 4.
- The use of NSAIDs in sports medicine should be cautious and situation- and pathology-specific, with a preference for simple analgesia and minimization of dose and duration 4.