Mason Lorna, Moore R Andrew, Edwards Jayne E, Derry Sheena, McQuay Henry J
Pain Research and Nuffield Department of Anaesthetics, University of Oxford, Oxford Radcliffe Hospital, The Churchill, Headington, Oxford, OX3 7LJ, UK.
BMC Musculoskelet Disord. 2004 Aug 19;5:28. doi: 10.1186/1471-2474-5-28.
: 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. 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.
Twelve new trials were added to 13 trials from a previous review. 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.
先前的一项系统评价报告称，局部用非甾体抗炎药在缓解骨关节炎和肌腱炎等慢性疾病的疼痛方面有效。更多的试验、对试验质量和偏倚的更好理解以及某些药物的重新分类需要进行新的评价。
通过检索电子数据库和致函制造商来确定研究。我们纳入了比较局部用非甾体抗炎药与安慰剂或另一种活性治疗药物对慢性疼痛成人患者疗效的随机双盲试验。主要结局为两周时疼痛减轻约50%，次要结局为局部和全身不良事件以及因不良事件导致的撤药。计算相对获益和需治疗人数（NNT）以及相对危害和需伤害人数（NNH），并通过敏感性分析研究试验质量、有效性和规模、报告的结局以及治疗的疾病状况的影响。
在先前评价的13项试验基础上新增了12项新试验。14项双盲安慰剂对照试验纳入了近1500例患者的信息。局部用非甾体抗炎药显著优于安慰剂，相对获益为1.9（95%置信区间1.7至2.2），NNT为4.6（95%置信区间3.8至5.9）。结果不受试验质量、有效性或规模、报告的结局或治疗的疾病状况的影响。3项纳入764例患者比较局部用非甾体抗炎药与口服非甾体抗炎药疗效的试验未发现疗效差异。局部用非甾体抗炎药和安慰剂的局部不良事件（6%）、全身不良事件（3%）或因不良事件撤药的人数相同。
局部用非甾体抗炎药在治疗慢性肌肉骨骼疾病两周时有效且安全。需要进行更大规模和更长时间的试验以充分阐明局部用非甾体抗炎药在临床实践中的地位。
