Topical NSAIDs Provide Only Temporary Relief for Osteoarthritis Pain
More than 20 million Americans have ]]>osteoarthritis]]> , a number that is only expected to increase as our population ages. Osteoarthritis is caused by a breakdown of cartilage in the joints, and can occur from years of normal wear and tear. It’s a major cause of disability among older adults.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin, are widely used to treat the pain and inflammation associated with osteoarthritis. Despite their effectiveness, however, some people who use NSAIDs experience gastrointestinal side effects, such as ulcers or bleeding. Topically applied NSAIDs, which essentially carry no risk of gastrointestinal side effects, have been used for years as an alternative. But are they effective at relieving pain?
A previous review suggested that topical NSAIDs were superior to a placebo in decreasing pain due to osteoarthritis and tendonitis over a two-week period. But what about beyond two weeks? A new study in the August 7, 2004 issue of the British Journal of Medicine found that using topical NSAIDs to relieve the pain of osteoarthritis is only beneficial for the first two weeks and not beyond.
About the Study
The researchers looked at 13 previously conducted studies that compared the effectiveness of topical NSAIDs with a placebo or oral NSAIDs in treating osteoarthritis. Combined, these studies represented data from 1983 people with osteoarthritis. Specifically, the researchers measured pain reduction and improvements in function and stiffness, and compared side effects for the different treatment options.
The results showed that topical NSAIDs were more effective than a placebo at reducing pain and improving function and stiffness, but only for the first two weeks of treatment. Furthermore, oral NSAIDs were more effective at reducing pain than topical NSAIDs from the onset.
Although fewer people taking topical NSAIDs had adverse reactions or gastrointestinal side effects than those taking oral NSAIDs, not unexpectedly, more had local side effects, such as rashes, itching, and burning.
When performing their analyses, the researchers took into account the fact that the studies included in their review used a variety of topical NSAIDs, which may have affected the degree of pain relief observed in each study.
How Does This Affect You?
This study found that topical NSAIDs are not effective at treating the pain associated with osteoarthritis for durations longer than two weeks. This suggests that they may not be the ideal treatment choice for people with osteoarthritis, a long-term chronic condition.
So should you stop using topical NSAIDs for osteoarthritic pain relief? Probably not, since topical NSAIDS may still have a place in osteoarthritis treatment during short-term flare-ups, another area that needs further study. However, there is now little evidence to support their use for the long-term management of osteoarthritis.
Currently, standard treatment for osteoarthritis includes physical therapy, weight control, and pain management with NSAIDs and other pain medications. Corticosteroids injected into the joint can also be used to temporarily relieve pain, but are not recommended for more than two or three treatments per year. For some people, surgery may also be an option, however this should be reserved for instances when non-invasive treatment methods have failed to provide relief.
The most effective treatment for osteoarthritis is generally a combination of methods and will vary from one person to the next. If you have osteoarthritis it’s important to work closely with your health care provider to find what works best for you.
Handout on Health: Osteoarthritis
National Institute of Arthritis and Musculoskeletal Diseases
National Institutes of Health.
Cooper C, Jordan KM. Topical NSAIDs in osteoarthritis. BMJ. 2004; 329:304-305.
Handout on Health: Osteoarthritis. National Institute of Arthritis and Musculoskeletal Diseases. National Institutes of Health. Available at: http://www.niams.nih.gov/hi/topics/arthritis/oahandout.htm . Accessed on August 5, 2004.
Lin J, Zhang W, Jones A, and Doherty M. Efficacy of topical non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis: meta-analysis of randomized controlled trials. BMJ. 2004; 329:324.
Last reviewed Aug 6, 2004 by ]]>Richard Glickman-Simon, MD]]>
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