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.