Advice to use topical or oral ibuprofen for chronic knee pain in older people: randomised controlled trial and patient preference study.
OBJECTIVE
To determine whether older patients with chronic knee pain should be advised to use topical or oral non-steroidal anti-inflammatory drugs (NSAIDs).


METHODS
Randomised controlled trial and patient preference study.


METHODS
26 general practices.


METHODS
People aged > or =50 with knee pain: 282 in randomised trial and 303 in preference study.


METHODS
Advice to use topical or oral ibuprofen. Primary outcome measures WOMAC (Western Ontario and McMaster Universities) osteoarthritis index, major and minor adverse effects.


RESULTS
Changes in global WOMAC scores at 12 months were equivalent. In the randomised trial the difference (topical minus oral) was two points (95% confidence interval -2 to 6); in the preference study, it was one point (-4 to 6). There were no differences in major adverse effects in the trial or study. The only significant differences in secondary outcomes were in the randomised trial. The oral group had more respiratory adverse effects (17% v 7%,95% confidence interval for difference -17% to -2%), the change in serum creatinine was 3.7 mmol/l less favourable (0.9 micromol/l to 6.5 micromol/l); and more participants changed treatments because of adverse effects (16% v 1%, -16% to -5%). In the topical group more participants had chronic pain grade III or IV at three months, and more participants changed treatment because of ineffectiveness.


CONCLUSIONS
Advice to use oral or topical preparations has an equivalent effect on knee pain over one year, and there are more minor side effects with oral NSAIDs. Topical NSAIDs may be a useful alternative to oral NSAIDs.


BACKGROUND
ISRCTN 79353052.
Underwood
Martin
M
Centre for Health Sciences, Barts and The London, Queen Mary, University of London, London E1 2AT.
Ashby
Deborah
D
Cross
Pamela
P
Hennessy
Enid
E
Letley
Louise
L
Martin
Jeannett
J
Mt-Isa
Shahrul
S
Parsons
Suzanne
S
Vickers
Madge
M
Whyte
Ken
K
D000284:Administration, Oral; D000287:Administration, Topical; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage* / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage* / Q000009:adverse effects; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control*; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011788:Quality of Life; D016896:Treatment Outcome
D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007052:Ibuprofen