Oral NSAIDs are more common for managing musculoskeletal pain, and have been widely used for years. Topical NSAIDs are less popular, say the researchers in a review in the Cochrane Library.
The team of reviewers evaluated 34 studies involving 7,688 adults with chronic musculoskeletal pain for a period of at least three months. Participants were organised into groups using either a topical NSAID applied at least once daily; a placebo; or an oral NSAID.
The reviewers found topical NSAID use 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 eight to 12 weeks.
Lead reviewer Dr Sheena Derry, of the Pain Research and Nuffield Department of Clinical Neurosciences at the University of Oxford says, however, that the use of topical formulations is limited to conditions where the pain is "near to the surface".
"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," says Derry.
"This means you don't get the gastrointestinal problems that are associated with and cause so many problems with oral ones."
Dr Roger Chou, a US assistant professor of medicine at Oregon Health & Science University and expert in pain management, says the review findings are similar to his past research, and consistent with what he would expect to see.
"I think one thing to remember is that for topical medications to work, (the pain) has to be fairly localised," says Chou.
"It would be tough to use these NSAIDs for fibromyalgia, where the pain is all over the body, or back pain, where the pain is typically in the deeper structures."
Many patients and doctors perceive topical NSAIDS to be weaker than pills, Chou says.
"As we learn more about effectiveness, and perhaps as the cost comes down, people will use them more."
Source: Newswise/Health Behaviour News Service via Business Day
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