A blog, originally published on Evidently Cochrane, for non-medical readers by Lynda Ware, Senior Fellow in General Practice with Cochrane UK.

“Just put some cream on it….”

According to my three daughters, this was my stock response to any request they made for motherly intervention when pain struck. Whilst refuting this slur utterly (and the one about not even looking), I might now point them in the direction of this updated review, which assesses the efficacy and safety of topical nonsteroidal anti-inflammatory drugs (NSAIDs), albeit in the context of chronic musculoskeletal pain rather than a bruised shin or finger. What’s more, I will point out that it’s likely that the carrier, to which the active drug is added, is pretty effective in its own right.

Why is this important?

Applying topical NSAIDs to the site of the pain seems a logical thing to do. They can act precisely where they are needed without first having to be absorbed via the stomach and then transported in the blood. This reduces the possibility of side-effects such as gastric irritation.

Topical NSAID formulations act most effectively on more superficial sites of pain such as in osteoarthritic joints in the hands and knees. They are not indicated for treatment of deeper seated joints such as hips or spine, or for deep visceral pain or headaches. They come in various forms such as creams, gels, sprays and plasters. It is important not to apply them to broken skin.

What does this review look at?

This review, from the Cochrane Pain, Palliative and Supportive Care Group, is an update of the original systematic review published in 2012. Five new studies have been added, bringing the total to thirty-nine. The number of participants is now 10,631- an increase of 38%. Most of the studies compared a topical NSAID with its carrier constituent; other studies made a comparison with other active preparations. In all of the studies the chronic musculoskeletal condition was osteoarthritis, mainly in the knees. The participants were aged 16 and above and had suffered chronic musculoskeletal pain of at least moderate intensity for at least three months. The mean age in the studies ranged from 59 to 65 years, with some studies including participants aged 90 years or more. Most studies looked at diclofenac or ketoprofen in solution and gel.