title: Is there any role for topical non-steroidal anti-inflammatory drugs in the treatment of mild to moderate musculoskeletal pain in a Lebanese community pharmacy?
abstract: BACKGROUND
  Non-steroidal anti-inflammatory drugs (NSAIDs) are widely prescribed in the community pharmacy. Their systemic administration has been related to significant adverse effects. The aim of this study was to evaluate the efficacy of topical NSAIDs in managing mild to moderate musculoskeletal pain versus systemic administration or combination of both routes.
  
  
  METHODS
  This was a prospective observational study conducted in a large Lebanese community pharmacy over a period of 5 months in 302 patients. Participants were divided into three groups according to their route of administration of NSAIDs either topically, systemically or combination of both. During follow up period, degree of pain, efficacy of NSAID therapy, side effects, onset time and duration of pain relief reported by each patient were collected by the study investigators using specific formulated questionnaire. Degree of pain was assessed using the Numeric Rating Scale (NRS-11). The efficacy of NSAID therapy was defined as 50 % reduction or more in pain. The primary outcome was to assess the efficacy between groups. The secondary outcomes were onset time, duration of pain relief and side effects between the three groups.
  
  
  RESULTS
  A total of 149 patients were enrolled in this study. 78 patients administered topical NSAIDs, 40 administered systemic NSAIDs and 31 administered combination of both routes. Efficacy of NSAID therapy for all routes was reported in 132 participants (89 %) distributed as 64 in topical, 37 in systemic and 31 in combination. Bi-variate analysis showed no significant difference in efficacy between topical versus systemic (p = 0.99) and topical versus combination (p = 0.14). The mean onset of topical NSAIDs was significantly faster than systemic by 12.7 min (p < 0.05). The mean duration of pain relief of systemic NSAIDs was significantly longer than topical by 3 h (p < 0.05). Patients administered systemic NSAIDs (either alone or in combination) reported increase in blood pressure and gastric-upset 8 and 38 cases, respectively.
  
  
  CONCLUSIONS
  There was no significant statistical difference between NSAIDs route's of administration for the treatment of mild to moderate musculoskeletal pain in Lebanese community pharmacy patients. Topical NSAIDs were fast in onset and effective in reducing pain with no significant adverse effects.
authors.affiliation: Department of Pharmaceutical Sciences, School of Pharmacy, Lebanese International University, Mazraa, Beirut, 146404 Lebanon.
authors.forename: Ahmad I
authors.initials: AI
authors.lastname: Dimassi
authors.affiliation: Department of Pharmaceutical Sciences, School of Pharmacy, Lebanese International University, Mazraa, Beirut, 146404 Lebanon.
authors.forename: Mohamad K
authors.initials: MK
authors.lastname: Rahal
authors.affiliation: Department of Pharmaceutical Sciences, School of Pharmacy, Lebanese International University, Mazraa, Beirut, 146404 Lebanon.
authors.forename: Mohamad M
authors.initials: MM
authors.lastname: Iskandarani
authors.affiliation: Department of Pharmacy Practices, School of Pharmacy, Lebanese International University, Mazraa, Beirut, 146404 Lebanon.
authors.forename: Etwal P
authors.initials: EP
authors.lastname: BouRaad
keywords: Combination; Mild to moderate musculoskeletal pain; NSAIDs; Systemic; Topical