The efficacy of non-steroidal anti-inflammatory drugs (NSAIDS) for shoulder complaints. A systematic review.
The medical literature was evaluated with respect to the efficacy of NSAIDs for shoulder complaints. Nineteen randomized clinical trials met the selection criteria and were included in this review. Each publication was independently scored by two blinded reviewers, according to a standardized set of 17 methodological criteria. The studies were ranked according to their total methods score (maximum 100 points). The methodological quality of the majority of the studies was rather disappointing; only 5 trials received a methods score exceeding 50 points. Furthermore, methodological criteria were often inadequately described, particularly those regarding the randomization procedure, co-interventions and control of compliance. The three trials with the highest methods scores demonstrated superior short-term efficacy of NSAIDs in comparison with placebo intervention. Fourteen trials comparing two types of NSAIDs showed no conclusive evidence in favour of a particular NSAID with respect to efficacy or tolerability. Future studies should compare the benefit-risk ratios of NSAIDs and analgesics for shoulder complaints in order to establish whether the use of NSAIDs is more favourable than analgesics, despite the higher risk of adverse reactions from NSAIDs.
van der Windt
D A
DA
Institute for Research in Extramural Medicine, Faculty of Medicine, Vrije Universiteit, Amsterdam, The Netherlands.
van der Heijden
G J
GJ
Scholten
R J
RJ
Koes
B W
BW
Bouter
L M
LM
D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007592:Joint Diseases / Q000188:drug therapy; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012785:Shoulder Joint
D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal