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Topical NSAIDs and pain relief

Topical NSAIDs are systemically absorbed but their plasma concentrations
are around 15% of those following oral administration of the same dose.

They can be effective in relieving pain in acute and chronic
musculoskeletal disorders including osteoarthritis, tendonitis and
muscle strains.1

A recent gold-standard review by the Cochrane
Collaboration 2 included 47 studies, most of which compared topical
NSAIDs in the form of a gel, spray, or cream with a similar placebo in
3,455 participants.3

For all topical NSAIDs combined, compared with
placebo, the number needed to treat to benefit for clinical success
defined as equivalent to 50% pain relief - was 4.5 for treatment periods
of 6 to 14 days. 3

Topical diclofenac, ibuprofen, ketoprofen, and
piroxicam were of similar efficacy, but indomethacin and benzydamine
were not significantly better than placebo.3

Local skin reactions were generally mild and transient, and did not differ from placebo. There
were very few systemic adverse events or withdrawals due to adverse
events. 3

With respect to topical NSAIDs in osteoarthritis, NICE suggests that
healthcare professionals should consider offering topical NSAIDs for
pain relief for people with knee or hand osteoarthritis and that topical
NSAIDs and/or paracetamol should be considered ahead of oral NSAIDs,
COX-2 inhibitors or opioids.4

1. Pulse. Prescribing analgesics and NSAIDs. Sept2010
2. Cochrane Database of Systematic Reviews 2010, Issue 6. Art. No.:
3. Pulse. Topical NSAIDs usually better option than oral. Jun 2010
4. GPnotebook. Topical non-steroidal anti-inflammatory drugs (NSAIDs) in