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Cochrane systematic review
Topical NSAIDs provide effective relief of acute musculoskeletal pain compared to placebo, with no increase in risk of adverse effects
  1. Rachelle Buchbinder
  1. Monash Department of Clinical Epidemiology, Cabrini Hospital; and Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
  2. Cabrini Hospital and Monash University, Victoria, Australia
  1. Correspondence to Rachelle Buchbinder
    Suite 41 Cabrini Medical Centre, 183 Wattletree Road, Malvern, Victoria 3144, Australia; rachelle.buchbinder{at}

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Acute musculoskeletal pain due to sprains and strains and sporting injuries are a common occurrence. Usual treatment includes rest, ice, compression and elevation; simple analgesia, oral non-steroidal anti-inflammatory drugs (NSAIDs); and various over-the-counter or prescription topical NSAIDs and rubefacients.


In evaluating the evidence for the efficacy and safety of topical NSAIDs for acute musculoskeletal pain, Massey and colleagues identified randomised double-blind trials in adults (16 years or older) that compared topical NSAIDs, applied at least once daily, with placebo or an active treatment.

Trials were included only if there were at least 10 participants per arm, outcomes were measured close to 7 days and if they provided data for the primary outcome of ‘clinical success’ defined as a 50% reduction in patient-reported pain or equivalent categorical measure. Secondary outcomes were number of patients with adverse events (local and systemic) and number of withdrawals (all causes, due to lack of efficacy and adverse events).

Data sources used to identify relevant trials included MEDLINE, EMBASE, Cochrane CENTRAL, …

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  • Competing interests None.