Topical NSAIDs are better than placebo

BMJ 1998;317:280 ( 25 July )

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Topical NSAIDs are better than placebo

Safety, efficacy, and therapeutic role of NSAIDs must be clarified

Authors' reply

Safety, efficacy, and therapeutic role of NSAIDs must be clarified

The first 150 words of the full text of this article appear below.

EDITOR $---$ Moore et al concluded in their study that topical non-steroidal anti-inflammatory drugs are better than placebo inacute and chronic musculoskeletal pain.¹ Does this help todefine their role in practice?

While we accept that these agents are better than placebo (this is considered during drug licensing), this does not help todecide how clinically effective they are. To define a therapeuticrole for these preparations² we need comparisons with other interventions, such as oral non-steroidal anti-inflammatory drugs, topical rubefacients, or paracetamol. Of the 87 trials reviewedby Moore et al only five compared topical with oral non-steroidal anti-inflammatory drugs, and none had adequate design or powerto enable comparison.

We are also concerned about the methodology used in this review. Moore et al conclude that the trials reviewed were of a goodquality. We recently reviewed this area and found that many trialshad poor methodology, low numbers . . . [Full text of this article]

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Relevant Article

Quantitive systematic review of topically applied non-steroidal anti-inflammatory drugs: R A Moore, M R Tramèr, D Carroll, P J Wiffen, and H J McQuay
BMJ 1998 316: 333-338. [Abstract] [Full Text] [PDF]