Topical NSAIDs provide effective relief of acute musculoskeletal pain compared to placebo, with no increase in risk of adverse effects
- Department of Nursing Practice Innovations, University of Wisconsin Hospital & Clinics, Madison, Wisconsin, USA
- Correspondence to Debra B Gordon
600 Highland Avenue, Mail Code 6736, Madison, WI 53792, USA;
Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for acute and chronic inflammatory painful conditions. NSAIDs produce analgesia by inhibition of the enzyme mediating production of prostaglandins and thromboxane.1 Systemic administration of NSAIDs produces relatively high blood concentrations that can lead to serious adverse events including gastrointestinal bleeding, renal failure and precipitation of congestive heart failure and other cardiovascular events.2 3 Topical application may reduce these risks by avoiding circulation to all parts of the body that accompany oral, rectal and intravenous administration. Topical formulations have limited tissue penetration with minimal uptake into the systemic circulation. This route is indicated for superficial and well-defined areas with intact skin and is not appropriate for deeper structures (eg, spine or organs). Unlike compounded creams, gels and sprays, topical formulations are engineered with prodrug esters or as microemulsions in order to penetrate the skin.
Rigorous review of ample evidence
This is part of a review series and was thus restricted …