Nsaids Review Article Text

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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. Studies 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.

Analytical Phd Thesis

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. 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. Topical 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. The online version of this article doi: 10.​1186/​1471 2474 5 28 contains supplementary material, which is available to authorized users.

A systematic review of topical nsaids reported that they were effective for relieving pain in both acute and chronic conditions 1 . Number needed to treat nnt , the number of patients that need to be treated for one to benefit from a particular drug, who would not have benefited from placebo, was used to estimate efficacy. There are three reasons why an updated review of topical nsaids in chronic pain is needed. First, we have a better appreciation of factors that can introduce bias 2 – 4 , and would not now accept trials that were not double blind, or were very small.

Second, topical salicylate and benzydamine are no longer classed as topical nsaids 5 . We believed that updating the review would improve efficacy estimates for topical nsaids, with a prior intent to determine efficacy for individual drugs. Relevant studies were sought regardless of publication language, type, date or status. Studies included in the previous review were considered for inclusion, and the cochrane library, medline and premedline, embase and pubmed, were searched for relevant studies published since the last review, for the years 1996 to april 2003. The search strategy included application: topical together with cream , gel etc, together with generic names of nsaids, and proprietary preparations of topical treatment in which the principal active ingredient was an nsaid 6.

We wrote to 20 pharmaceutical companies in the uk, 66 in continental europe, and two in north america, known to manufacture topical nsaids, asking if they could supply papers. We identified reports of randomised, double blind, active or placebo controlled trials in which treatments were given to adult patients with moderate to severe chronic pain resulting from musculoskeletal or other painful disorders. At least ten patients had to be randomised to a treatment group and application of treatment had to be at least once daily. Trial quality was assessed using a validated three item scale with a maximum quality score of five 8 . Included studies had to score at least two points, one for randomisation and one for blinding. Quality and validity assessments were made independently by at least two reviewers and verified by one other reviewer.

We defined our own outcome of clinical success, representing approximately a 50% reduction in pain 1 . This was either the number of patients with a good or excellent global assessment of treatment, or none or slight pain on rest or movement or comparable wording measured on a categorical scale. A hierarchy of outcomes was used to extract efficacy information 1 , shown below in order of preference: nonsteroidal anti inflammatory drugs nsaids , including both traditional nonselective nsaids and the selective cyclooxygenase cox 2 inhibitors, are widely used for their anti inflammatory and analgesic effects. Nsaids are a necessary choice in pain management because of the integrated role of the cox pathway in the generation of inflammation and in the biochemical recognition of pain.

This group of drugs has recently come under scrutiny because of recent focus in the literature on the various adverse effects that can occur when applying nsaids. This review will provide an educational update on the current evidence of the efficacy and adverse effects of nsaids. It aims to answer the following questions: 1 are there clinically important differences in the efficacy and safety between the different nsaids, 2 if there are differences, which are the ones that are more effective and associated with fewer adverse effects, and 3 which are the effective therapeutic approaches that could reduce the adverse effects of nsaids. Finally, an algorithm is proposed which delineates a general decision making tree to select the most appropriate analgesic for an individual patient based on the evidence reviewed. keywords: analgesics, cox 2 specific inhibitors, nsaids, pain nonsteroidal anti inflammatory drugs nsaids are among the most widely used medications in the world because of their demonstrated efficacy in reducing pain and inflammation. 1 their efficacy has been documented in a number of clinical disorders, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, gout, dysmenorrhea, dental pain and headache. 2 x02013 8 the basic mode of action is inhibition of the pro inflammatory enzyme cyclooxygenase cox.

Columbia University Department of Economics Discussion Paper Series

Nsaids as a class comprise both traditional nonselective nsaids tnsaids that nonspecifically inhibit both cox 1 and cox 2, and selective cox 2 inhibitors. Although effective at relieving pain and inflammation, tnsaids are associated with a significant risk of serious gastrointestinal adverse events with chronic use. 9 therefore, specific inhibitors of the cox 2 isoenzyme were developed, thus opening the possibility to provide anti inflammatory and analgesic benefits, while theoretically leaving the gastroprotective activity of the cox 1 isoenzyme intact. However, important concerns have recently been raised regarding the potential cardiovascular toxicity of cox 2 inhibitors. 10 this review will provide an educational update of the scientific evidence for the efficacy and adverse effects of nsaids in view of the emerging new information for this class of drugs.

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