Evidence map›Paper›PMID 9487165›Full record

SynthesisBMJ (Clinical research ed.)1998

Quantitative systematic review of topically applied non-steroidal anti-inflammatory drugs.

R A Moore, M R Tramèr, D Carroll, P J Wiffen, H J McQuay

Erratum issued Registry-linked trialOpen access · bronzeAbstract readMeta-AnalysisSystematic Review

In one paragraph

Synthesis in BMJ (Clinical research ed.), 1998. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. 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 93 papers, 24 of them syntheses that pooled it.

0numbers the graph read from it

0cells of the map it votes in

93citing papers in PubMed, 24 pooled it

70.9field-weighted citation impact, top 1% 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

93 citing papers in PubMed, 24 syntheses or guidelines pooled it, 447 citations in OpenAlex.

Efficacy and safety of different topical diclofenac formulations for the treatment of knee osteoarthritis: a meta-analysis of short-term and long-term treatment comparisons.BMC musculoskeletal disorders · 2025
Pooled it
Topical diclofenac therapy for osteoarthritis: a meta-analysis of randomized controlled trials.Clinical rheumatology · 2016
Pooled it
Topical NSAIDs for chronic musculoskeletal pain in adults.The Cochrane database of systematic reviews · 2016
Pooled it
Topical NSAIDs for acute musculoskeletal pain in adults.The Cochrane database of systematic reviews · 2015
Pooled it
Salicylate-containing rubefacients for acute and chronic musculoskeletal pain in adults.The Cochrane database of systematic reviews · 2014
Pooled it
Carbamazepine for chronic neuropathic pain and fibromyalgia in adults.The Cochrane database of systematic reviews · 2014
Pooled it
Topical NSAIDs for chronic musculoskeletal pain in adults.The Cochrane database of systematic reviews · 2012
Pooled it
Topical capsaicin (low concentration) for chronic neuropathic pain in adults.The Cochrane database of systematic reviews · 2012
Pooled it
Carbamazepine for acute and chronic pain in adults.The Cochrane database of systematic reviews · 2011
Pooled it
Topical NSAIDs for acute pain in adults.The Cochrane database of systematic reviews · 2010
Pooled it
Adverse effects of topical nonsteroidal antiinflammatory drugs in older adults with osteoarthritis: a systematic literature review.The Journal of rheumatology · 2010
Pooled it
Topical capsaicin for chronic neuropathic pain in adults.The Cochrane database of systematic reviews · 2009
Pooled it
Topical rubefacients for acute and chronic pain in adults.The Cochrane database of systematic reviews · 2009
Pooled it
Single dose oral diclofenac for acute postoperative pain in adults.The Cochrane database of systematic reviews · 2009
Pooled it
Systematic review of dexketoprofen in acute and chronic pain.BMC clinical pharmacology · 2008
Pooled it
Shoulder adhesive capsulitis: systematic review of randomised trials using multiple corticosteroid injections.The British journal of general practice : the journal of the Royal College of General Practitioners · 2007
Pooled it
EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT).Annals of the rheumatic diseases · 2007
Guideline
Analgesic therapy in postherpetic neuralgia: a quantitative systematic review.PLoS medicine · 2005
Pooled it
Topical NSAIDs for chronic musculoskeletal pain: systematic review and meta-analysis.BMC musculoskeletal disorders · 2004
Pooled it
Efficacy of topical non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis: meta-analysis of randomised controlled trials.BMJ (Clinical research ed.) · 2004
Pooled it

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

4 · The record

Corrections and comments

Commented on by
Topical NSAIDs are better than placebo. Safety, efficacy, and therapeutic role of nsaids must be clarified.1998
Commented on by
Erratum issued

5 · Who and what money

Authors and funding

5 authors at 2 institutions in 1 country.

R A MooreUniversity of Oxford, Oxford Radcliffe Hospital, Headington. andrew.moore@pru.ox.ac.uk

M R Tramèr

D Carroll

P J Wiffen

H J McQuay

University of Oxford · GBChurchill Hospital · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo review the effectiveness and safety of topical non-steroidal anti-inflammatory drugs in acute and chronic pain conditions.

designQuantitative systematic review of randomised controlled trials. DATA SOURCES: 86 trials involving 10,160 patients.

main outcome measuresMeasures 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.

resultsIn 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.

conclusionTopical non-steroidal anti-inflammatory drugs are effective in relieving pain in acute and chronic conditions.

Indexed as

Sprains and StrainsAcute DiseaseAdministration, TopicalAnti-Inflammatory Agents, Non-SteroidalChronic DiseaseDrug CombinationsHumansPainRandomized Controlled Trials as TopicTreatment OutcomeAnti-Inflammatory Agents, Non-SteroidalDrug Combinations

Identifiers

PMID9487165

DOI10.1136/bmj.316.7128.333

PMCPMC2665568

OpenAlexW2031268164

What OpenQuestion holds

Textmetadata

Read underepoch 390

Registered trials

NCT00471393ClinicalTrials.gov

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.