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. 2015 Jun 15;2015(6):CD007402. doi: 10.1002/14651858.CD007402.pub3

Summary of findings for the main comparison. Topical NSAIDs compared with topical placebo for acute musculoskeletal pain in adults.

Topical NSAIDs compared with topical placebo for acute musculoskeletal pain in adults
Patient or population: adults with strains, sprains, or muscle pull
Settings: community
Intervention: topical NSAID (topical diclofenac, ibuprofen, and ketoprofen gels only shown here for efficacy)
Comparison: topical placebo
Outcomes Probable outcome with
 intervention Probable outcome with
 comparator RR, NNT, NNTp, or NNH
 (95% CI) No of studies, participants Quality of the evidence
 (GRADE) Comments
Topical diclofenac gel (as Emulgel)
Clinical success (eg 50% reduction in pain)
780 in 1000 200 in 1000 RR
3.4 (2.7 to 55)
NNT
1.8 (1.5 to 2.1)
2 studies
314 participants
High Consistent results in 2 moderately sized recent studies of high quality
Topical ibuprofen gel
Clinical success (eg 50% reduction in pain)
420 in 1000 160 in 1000 RR
2.7 (1.7 to 4.2)
NNT
3.9 (2.7 to 6.7)
2 studies
241 participants
Moderate Modest effect size and numbers of participants
Topical ketoprofen gel
Clinical success (eg 50% reduction in pain)
720 in 1000 330 in 1000 RR
2.2 (1.7 to 2.8)
NNT
2.5 (2.0 to 3.4)
5 studies
348 participants
Moderate Modest effect size and numbers of participants, but studies small, with none recent
All topical NSAIDs
Local adverse events
46 in 1000 50 in 1000 RR
1.0 (0.80 to 1.2)
NNH not calculated
42 studies
6125 participants
High Large number of studies and participants with consistent results
All topical NSAIDs
Systemic adverse events
32 in 1000 35 in 1000 RR
1.0 (0.7 to 1.3)
NNH not calculated
38 studies
5372 participants
High Large number of studies and participants with consistent results
All topical NSAIDs
Withdrawals ‐ adverse events
11 in 1000 11 in 1000 RR
1.0 (0.7 to 1.7)
NNH not calculated
42 studies
5790 participants
High Large number of studies and participants with consistent results
Serious adverse events 1 in total 0 in total Not calculated All data Low Small numbers of events
GRADE Working Group grades of evidence
 High quality: Further research is very unlikely to change our confidence in the estimate of effect.
 Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
 Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
 Very low quality: We are very uncertain about the estimate.

CI: confidence interval; RR: risk ratio; NNT: number needed to treat for an additional beneficial outcome; NNTp: number needed to treat to prevent an event happening; NNH: number needed to treat for an additional harmful outcome.