Do topical NSAIDs work?

Abstract

Strong evidence supports the efficacy of oral NSAIDs in osteoarthritis treatment, but the benefit of long-term topical NSAIDs for chronic use, although available in some countries, is less clear. The approval by the FDA of diclofenac gel for the treatment of osteoarthritis knee pain has resurrected the clinical debate regarding which patients will benefit the most from each approach. Determining the comparative benefits of topical and oral NSAIDs in specific patients will aid clinical decision making; the extent of pain relief might be one measure of benefit, but others, such as patient preference, might also be useful. Underwood et al. have reported an interesting approach to measuring the utility of these two therapeutic strategies. This commentary critically reviews this approach in the context of similar investigations.