Evidence map›Paper›PMID 15317652›Full record

SynthesisBMC musculoskeletal disorders2004

Topical NSAIDs for chronic musculoskeletal pain: systematic review and meta-analysis.

Lorna Mason, R Andrew Moore, Jayne E Edwards, Sheena Derry, Henry J McQuay

Registry-linked trialOpen access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC musculoskeletal disorders, 2004. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00471393 (Double-blind Randomized Clinical Study on Topical Diclofenac Efficacy in Symptomatic Relief of Temporomandibular Degenerative Joint Disease in Women.), which is not on this map. Cited by 64 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
64citing papers in PubMed, 11 pooled it
5.2field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00471393 nacompletednot on this mapstarted 2006, after this paper: background citation

Double-blind Randomized Clinical Study on Topical Diclofenac Efficacy in Symptomatic Relief of Temporomandibular Degenerative Joint Disease in Women.

TypeinterventionalSponsorUniversity of AlbertaRan2006 to 2007Enrolled28ConditionsTemporomandibular Degenerative Joint DiseaseArms1.5% diclofenac in 45.5% DMSO (topical treatment), 45.5% DMSO (topical placebo)
3 · Its place in the literature

Who cites it

64 citing papers in PubMed, 11 syntheses or guidelines pooled it, 239 citations in OpenAlex.

  1. Guideline
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Topical NSAIDs for chronic musculoskeletal pain in adults.The Cochrane database of systematic reviews · 2016
    Pooled it
  7. Topical NSAIDs for acute musculoskeletal pain in adults.The Cochrane database of systematic reviews · 2015
    Pooled it
  8. Topical NSAIDs for chronic musculoskeletal pain in adults.The Cochrane database of systematic reviews · 2012
    Pooled it
  9. Topical NSAIDs for acute pain in adults.The Cochrane database of systematic reviews · 2010
    Pooled it
  10. Pooled it
  11. Topical rubefacients for acute and chronic pain in adults.The Cochrane database of systematic reviews · 2009
    Pooled it
  12. Trial
  13. Trial
  14. Trial
  15. Trial
  16. Trial
  17. Trial
  18. Trial
  19. Trial
  20. Review

4 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 2 institutions in 1 country.

Lorna MasonPain Research and Nuffield Department of Anaesthetics, University of Oxford, Oxford Radcliffe Hospital, The Churchill, Headington, Oxford, OX3 7LJ, UK. jayne.edwards@pru.ox.ac.uk
R Andrew Moore
Jayne E Edwards
Sheena Derry
Henry J McQuay
University of Oxford · GBChurchill Hospital · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

unlabelled: A previous systematic review reported that topical NSAIDs were effective in relieving pain in chronic conditions like osteoarthritis and tendinitis. More trials, a better understanding of trial quality and bias, and a reclassification of certain drugs necessitate a new review.

methodsStudies were identified by searching electronic databases, and writing to manufacturers. We identified randomised, double blind trials comparing topical NSAID with either placebo or another active treatment, in adults with chronic pain. The primary outcome was a reduction in pain of approximately 50% at two weeks, and secondary outcomes were local and systemic adverse events and adverse event-related withdrawals. Relative benefit and number-needed-to-treat (NNT), and relative harm and number-needed-to-harm (NNH) were calculated, and the effects of trial quality, validity and size, outcome reported, and condition treated, were examined by sensitivity analyses.

resultsTwelve new trials were added to 13 trials from a previous review. Fourteen double blind placebo-controlled trials had information from almost 1,500 patients. Topical NSAID was significantly better than placebo with relative benefit 1.9 (95% confidence interval 1.7 to 2.2), NNT 4.6 (95% confidence interval 3.8 to 5.9). Results were not affected by trial quality, validity or size, outcome reported, or condition treated. Three trials with 764 patients comparing a topical with an oral NSAID found no difference in efficacy. Local adverse events (6%), systemic adverse events (3%), or the numbers withdrawing due to an adverse event were the same for topical NSAID and placebo.

conclusionsTopical NSAIDs were effective and safe in treating chronic musculoskeletal conditions for two weeks. Larger and longer trials are necessary to fully elucidate the place of topical NSAIDs in clinical practice.

Indexed as

Administration, TopicalAnti-Inflammatory Agents, Non-SteroidalChronic DiseaseHumansIntractable PainMusculoskeletal DiseasesAnti-Inflammatory Agents, Non-Steroidal

Identifiers

PMID15317652
PMCPMC516039
OpenAlexW2125327054

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.