Systematic review of topical diclofenac for the treatment of acute and chronic musculoskeletal painPhilip J Wiffen et al. Curr Med Res Opin. 2020 Apr. Show
AbstractAim: The objective was to systematically review the efficacy and safety of topical diclofenac in both acute and chronic musculoskeletal pain in adults.Methods: We used standard Cochrane methods. Searches were conducted in MEDLINE, EMBASE and The Cochrane Register of Studies; date of the final search was November 2018. Included studies were randomized, double blinded, with ten or more participants per treatment arm. The primary outcome of "clinical success" was defined as participant-reported reduction in pain of at least 50%. Details of adverse events (AEs) were recorded.Results: For acute pain, 23 studies (5170 participants) were included. Compared to placebo, number needed to treat (NNT) for different formulations were as follows: diclofenac plaster, 4.7 (95% CI 3.7-6.5); diclofenac plaster with heparin, 7.4 (95% CI 4.6-19); and diclofenac Emulgel, 1.8 (95% CI 1.5-2.1). 4.1% (78/1919) reported a local AE. For chronic pain, 21 studies (26 publications) with 5995 participants were included. Formulations included gel, solution with or without DMSO, emulsion and plaster. A clinical success rate of ∼60% (NNT 9.5 [95% CI 7-14.7]) was achieved with a variety of formulations. Local AEs (∼14%) were similar for both diclofenac and placebo.Conclusion: This systematic review of 11,000+ participants demonstrates that topical diclofenac is effective for acute pain, such as sprains, with minimal AEs. The effectiveness of topical diclofenac was also demonstrated in chronic musculoskeletal pain but with a higher NNT (worse) compared with acute pain. Formulation does play a part in effectiveness but needs further studies. Keywords: NSAID; Systematic review; acute pain; chronic pain; diclofenac; topical NSAID. PubMed Disclaimer Similar articles
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A randomized, parallel control and multicenter clinical trial of evidence-based traditional Chinese medicine massage treatment VS External Diclofenac Diethylamine Emulgel for the treatment of knee osteoarthritis. Wen-Yue W, Ying-Peng X, Quan-Mao D, Li-Min X, De-Zhi W, Yang B, Li-Su W, Yu-Bin L, Zhi-Jun N, Yan-Xu M, Wu-Zhong C, Li-Qun B, Yang L, Li-Kun J. What is diclofenac sodium 1% topical gel used for?Descriptions. Diclofenac is used to treat pain and other symptoms of arthritis of the joints (eg, osteoarthritis), such as inflammation, swelling, stiffness, and joint pain. However, this medicine does not cure osteoarthritis and will help you only as long as you continue to use it. How long does it take diclofenac sodium 1% gel to work?Diclofenac sodium topical gel may take up to 7 days to work for your arthritis pain; it is not for immediate relief. With 4 times-a-day use, you may start to feel relief within a few days. You should feel significant pain relief within 7 days of continuous use. If no pain relief in 7 days, stop use. Why was diclofenac taken off the market?Used to combat pain and inflammation associated with arthritis, diclofenac was available in the U.S. as an over-the-counter drug until 2013, when the Food and Drug Administration restricted it to prescription-only use following reports of the drug causing heart damage. Is diclofenac sodium 1% the same as Voltaren?Nonprescription (over the counter) topical diclofenac comes as a 1% gel (Voltaren Arthritis Pain) to apply to up to 2 body areas (e.g., 1 knee and 1 ankle, 2 knees, 1 foot and 1 ankle, or 2 hands) 4 times daily for up to 21 days or as recommended by your doctor. |
