title: Quantitative systematic review of topically applied non-steroidal anti-inflammatory drugs.
abstract: OBJECTIVE
  To review the effectiveness and safety of topical non-steroidal anti-inflammatory drugs in acute and chronic pain conditions.
  
  
  METHODS
  Quantitative systematic review of randomised controlled trials.
  
  
  METHODS
  86 trials involving 10,160 patients.
  
  
  METHODS
  Measures of treatment success approximating at least 50% reduction in pain, local and systemic adverse effects. Analysis at 1 week for acute and 2 weeks for chronic conditions with relative benefit and number needed to treat.
  
  
  RESULTS
  In acute pain conditions (soft tissue trauma, strains, and sprains) placebo controlled trials had a relative benefit of 1.7 (1.5 to 1.9), the number needed to treat was 3.9 (3.4 to 4.4). With analysis by drug (at least three trials), ketoprofen (number needed to treat 2.6), felbinac (3.0), ibuprofen (3.5), and piroxicam (4.2) had significant efficacy. Benzydamine and indomethacin were no different from placebo. In chronic pain conditions (osteoarthritis, tendinitis) placebo controlled trials had a relative benefit of 2.0 (1.5 to 2.7); the number needed to treat was 3.1 (2.7 to 3.8). Small trials (< 40 treated patients) exaggerated effectiveness of topical non-steroidals by 33% in acute conditions but not in chronic conditions. There was no relation between trial quality and treatment effect. In both acute and chronic pain local and systemic adverse events and withdrawal from the study related to the drug had a low incidence and were no different from placebo.
  
  
  CONCLUSIONS
  Topical non-steroidal anti-inflammatory drugs are effective in relieving pain in acute and chronic conditions.
authors.affiliation: University of Oxford, Oxford Radcliffe Hospital, Headington. andrew.moore@pru.ox.ac.uk
authors.forename: R A
authors.initials: RA
authors.lastname: Moore
authors.forename: M R
authors.initials: MR
authors.lastname: Tramèr
authors.forename: D
authors.initials: D
authors.lastname: Carroll
authors.forename: P J
authors.initials: PJ
authors.lastname: Wiffen
authors.forename: H J
authors.initials: HJ
authors.lastname: McQuay
mesh_terms: D000208:Acute Disease; D000287:Administration, Topical; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D002908:Chronic Disease; D004338:Drug Combinations; D006801:Humans; D010146:Pain / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D013180:Sprains and Strains; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004338:Drug Combinations