Topical Therapy for Acute Pain in Adults
Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of medications that include ibuprofen (the active ingredient in Motrin® and Advil®), ketoprofen, diclofenac, piroxicam and indomethacin. Topical NSAIDs are widely used to treat acute musculoskeletal conditions due to their potential to provide pain relief without the side effects associated with these medications when they are taken orally.
Researchers at the University of Oxford, UK, reviewed the medical databases for randomized, double-blind, active or placebo-controlled trials in which treatments were administered to adult patients with acute pain resulting from strains, sprains or sports or overuse-type injuries (twisted ankle, for instance). Forty-seven studies were included in a meta-analysis; most compared topical NSAIDs in the form of a gel, spray, or cream with a similar placebo, with 3455 participants in the overall analysis of efficacy.
Clinical success was defined as 50% pain relief. For treatment periods of 6 to 14 days, topical diclofenac, ibuprofen, ketoprofen, and piroxicam were of similar efficacy, but indomethacin was not significantly better than placebo. Local skin reactions were generally mild and transient, and did not differ from placebo. With these topical medications, there were very few systemic adverse events or withdrawals due to adverse events. The analysis concluded: “Topical NSAIDs can provide good levels of pain relief, without the systemic adverse events associated with oral NSAIDs, when used to treat acute musculoskeletal conditions.”
Cochrane Database Syst Rev. 2010 Jun 16;6:CD007402.