Topical NSAIDs are better than placebo

doi:10.1136/bmj.317.7153.280a

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

Martin Duerden, Assistant medical director,
Stuart Barton, Medical director,
Elaine Johnstone, Senior pharmacist, MeReC Publications,
Kirsty MacLean, Pharmacist, MeReC Publications,
Jonathan Underhill, Pharmacist, MeReC Publications,
Tom Walley, Professor of pharmacology and therapeutics

National Prescribing Centre, The Infirmary, Liverpool L69 3GF
University of Liverpool, Liverpool L69 3GF
University of Oxford, Pain Relief Unit, Churchill Hospital, Oxford OX3 7LJ

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

While we accept that these agents are better than placebo (this is considered during drug licensing), this does not help to decide how clinically effective they are. To definea therapeutic role for these preparations2we need comparisons with other interventions, such as oral non-steroidal anti-inflammatory drugs, topical rubefacients, or paracetamol. Of the 87 trials reviewed by Moore et al only five compared topical with oral non-steroidal anti-inflammatory drugs, and none had adequate design or power to enable comparison.

We are also concerned about the methodology used in this review. Moore et al conclude that the trials reviewed were of a good quality. We recently reviewed this area and found that many trials had poor methodology, low numbers of patients, …