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  • General practitioners’ advice to use topical rather than oral ibuprofen resulted in equivalent effects on chronic knee painCommentary

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General practitioners’ advice to use topical rather than oral ibuprofen resulted in equivalent effects on chronic knee pain

https://doi.org/10.1136/ebn.12.1.25

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    M Underwood

    Professor M Underwood, University of Warwick, Coventry, UK; M.Underwood@warwick.ac.uk

    QUESTION

    For older patients with chronic knee pain, should general practitioners advise use of topical or oral non-steroidal anti-inflammatory drugs (NSAIDs)?

    METHODS

    Design:

    randomised controlled trial (Topical or Oral Ibuprofen [TOIB]).

    Allocation:

    concealed.

    Blinding:

    blinded (data collectors).

    Follow-up period:

    12 months.

    Setting:

    26 general practices in the UK.

    Patients:

    282 patients ⩾50 years of age (mean age 63 y, 54% women) with knee pain (97% with osteoarthritis). Exclusion criteria included history of, or awaiting, knee replacement, and recent knee injury.

    Intervention:

    the patient’s general practitioner recommended preferential use of topical ibuprofen (n = 138) or oral ibuprofen (n = 144).

    Outcomes:

    Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, adverse effects, and cost-effectiveness. The study had >80% power to show equivalence in WOMAC scores to within 10 mm (α = 0.05).

    Patient follow-up:

    88% (intention-to-treat …

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    Footnotes

    • Source of funding: Health Technology Assessment Programme; Goldshield Pharmaceuticals supplied starter packs of topical ibuprofen.