Purpose: We compared the effectiveness and harms of oral or topical nonsteroidal antiinflammatory drugs (NSAIDs) in the treatment of chronic pain from osteoarthritis, rheumatoid arthritis, soft tissue pain, back pain, and ankylosing spondylitis.
Data Sources: We searched Ovid MEDLINE® and the Cochrane Library and the Database of Abstracts of Reviews of Effects through May 2010. For additional data we also hand searched reference lists, US Food and Drug Administration medical and statistical reviews and dossiers submitted by pharmaceutical companies.
Review Methods: Study selection, data abstraction, validity assessment, grading the strength of the evidence, and data synthesis were all carried out according to standard Drug Effectiveness Review Project review methods.
Results and Conclusions: For pain relief, no significant short-term (< 6 months) differences were found among oral NSAIDs, topical NSAIDs, or between oral and topical NSAID. For serious harms, celecoxib does not appear to be associated with higher risk of cardiovascular events and is gastroprotective in the short term compared with nonselective NSAIDs. These findings vary by subgroup, depending on age, recent history of gastrointestinal bleeding, and concomitant use of antiulcer medication. Nonselective NSAIDs were associated with similar increased risks of serious gastrointestinal events, and all but naproxen were associated with similar increased risk of serious cardiovascular events, but the partially selective NSAID nabumetone was gastroprotective compared with nonselective NSAIDs. Compared with oral NSAIDs, topical diclofenac was gastroprotective but had higher risk of application site dryness. Application site reactions and withdrawals due to adverse events were higher with diclofenac 1.5% topical solution but not with diclofenac 1.0% topical gel compared with placebo.
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