Update on the use of topical NSAIDs for the treatment of soft tissue and musculoskeletal pain: A review of recent data and current treatment options

Physician and Sportsmedicine

Volumn 38, Issue 2, 2010, Pages 62-70

  Brewer, Alan R ^a   McCarberg, Bill ^b   Argoff, Charles E ^c  

^a Spinal Diagnostic/Pain Care Specialists   (United States)

^b KAISER PERMANENTE   (United States)

^c ALBANY MEDICAL COLLEGE   (United States)

Author keywords

Diclofenac; Musculoskeletal pain; Nonsteroidal anti inflammatory drugs; Pain; Soft tissue injuries; Topical analgesic therapy

Indexed keywords

BENZYDAMINE; CELECOXIB; DICLOFENAC; FELBINAC; FLURBIPROFEN; IBUPROFEN; IDEA 033; INDOMETACIN; KETOPROFEN; KETOROLAC; NAPROXEN; PIROXICAM; PLACEBO; SALICYLIC ACID; SUPROFEN; TRANSFERSOME; TROMETAMOL; UNCLASSIFIED DRUG; CYCLOOXYGENASE 2 INHIBITOR; NONSTEROID ANTIINFLAMMATORY AGENT;

ANKLE SPRAIN; ANTIINFLAMMATORY ACTIVITY; BLUNT TRAUMA; BURSITIS; CLINICAL TRIAL; DERMATITIS; DRUG EFFICACY; DRUG FORMULATION; DRUG SAFETY; DRUG TOLERABILITY; DYSGEUSIA; DYSPEPSIA; EPICONDYLITIS; HUMAN; JAUNDICE; KNEE OSTEOARTHRITIS; KNEE PAIN; LIVER FAILURE; LIVER NECROSIS; LIVER TOXICITY; MUSCULOSKELETAL PAIN; NAUSEA; NONARTICULAR RHEUMATISM; OPEN STUDY; PAIN ASSESSMENT; PHYSICAL ACTIVITY; PRURITUS; REVIEW; SKIN BURNING SENSATION; SOFT TISSUE INJURY; TENDINITIS; TREATMENT DURATION; TOPICAL DRUG ADMINISTRATION;

ADMINISTRATION, TOPICAL; ANTI-INFLAMMATORY AGENTS, NON-STEROIDAL; CYCLOOXYGENASE 2 INHIBITORS; HUMANS; MUSCULOSKELETAL PAIN; SOFT TISSUE INJURIES;

EID: 77955376564     PISSN: 00913847     EISSN: None     Source Type: Journal    
DOI: 10.3810/psm.2010.06.1784     Document Type: Review

References (60)

1. Almekinders LC. Anti-inflammatory treatment of muscular injuries in sport. An update of recent studies. Sports Med. 1999;28(6):383-388.
2. Paoloni JA, Orchard JW. The use of therapeutic medications for soft-tissue injuries in sports medicine. Med J Aust. 2005;183(7):384-388.
3. Stanos SP. Topical agents for the management of musculoskeletal pain. J Pain Symptom Manage. 2007;33(3):342-355.
4. McCleane G. Topical analgesics. Anesthesiol Clin. 2007;25(4):825-839, vii.
5. Dreiser RL. Topical antirheumatic drug therapy: current practice and future trends. Eur J Rheumatol Inflamm. 1994;14(4):3-8.
6. Heyneman CA, Lawless-Liday C, Wall GC. Oral versus topical NSAIDs in rheumatic diseases: a comparison. Drugs. 2000;60(3):555-574.
7. Haroutiunian S, Drennan DA, Lipman AG. Topical NSAID therapy for musculoskeletal pain. Pain Med. 2010;ll(4):535-549.
8. Flector Patch [prescribing information insert]. Bristol, TN: King Pharmaceuticals, Inc; 2009.
9. Voltaren Gel [prescribing information insert]. Wehr/Baden, Germany: Novartis Pharma Produktions; 2007.
10. PrPennsaid® (1.5% w/w diclofenac sodium solution); topical anti-inflammatory sodium solution. Control No. 104237. Montreal, Quebec, Canada: Squire Pharmaceuticals Inc. March 1, 2006.
11. National Institute for Health and Clinical Excellence. Osteoarthritis: the care and management of osteoarthritis in adults. NICE clinical guideline 59. http://www.nice.org.uk/nicemedia/pdf/CG59NICEguideline.pdf. Accessed April 26, 2010.
12. McCarberg B, D'Arcy Y. Target pain with topical peripheral analgesics. Nurse Pract. 2007;32(7):44-49.
13. Saillant G, Auguste P, Boyer C, et al. Study comparing the efficacy and tolerability of Flector Tissugel to that of a placebo in the treatment of benign ankle sprain [in French]. Medecine du Sport. 1998;72:1-5.
14. Galeazzi M, Marcolongo R. A placebo-controlled study of efficacy and tolerability of a nonsteriodal anti-inflamatory drug, DHEP plaster, in inflammatory peri- and extra-articular rheumatological diseases. Drugs Exp Clin Res. 1993;19(3):107-115.
15. Joussellin E. Flector Tissugel in the treatment of painful ankle sprain [in French]. J Traumatol Sport. 2003;20:1S5-1S9.
16. Butrón F, Galicia A, Zamora G, Martinez-Zurita F. Single blind study to evaluate the efficacy and safety of naproxen gel compared with diclophenac emulgel in the treatment of soft tissue injuries. Proc West Pharmacol Soc. 1994;37:153-156.
17. Diebschlag W, Nocker W, Bullingham R. A double-blind study of the efficacy of topical ketorolac tromethamine gel in the treatment of ankle sprain, in comparison to placebo and etofenamate. J Clin Pharmacol. 1990;30(l):82-89.
18. Petersen B, Rovati S. Diclofenac epolamine (Flector) patch: evidence for topical activity. Clin Drug Invest. 2009;29(1):l-9.
19. Brogden RN, Heel RC, Pakes GE, Speight TM, Avery GS. Diclofenac sodium: a review of its pharmacological properties and therapeutic use in rheumatic diseases and pain of varying origin. Drugs. 1980;20(l):24-48.
20. Rusca A, Mautone G, Sun S, Magelli M, Johnson F. Comparison of plasma pharmacokinetics of FLECTOR® Patch (diclofenac epolamine topical patch) and oral Voltaren® (diclofenac sodium enteric coated tablets) in healthy volunteers. J Pain. 2008;9(4 suppl 1):45.
21. Brune K. Persistence of NSAIDs at effect sites and rapid disappearance from side-effect compartments contributes to tolerability. Curr Med Res Opin. 2007;23(12):2985-2995.
22. Cannon CP, Curtis SP, FitzGerald GA, et al; MEDAL Steering Committee. Cardiovascular outcomes with etoricoxib and diclofenac in patients with osteoarthritis and rheumatoid arthritis in the Multinational Etoricoxib and Diclofenac Arthritis Long-term (MEDAL) programme: a randomised comparison. Lancet. 2006;368(9549):1771-1781.
23. Hadgraft J, Whitefield M, Rosher PH. Skin penetration of topical formulations of ibuprofen 5%: an in vitro comparative study. Skin Pharmacol Appl Skin Physiol. 2003;16(3):137-142.
24. Paolino D, Ventura CA, Nisticó S, Puglisi G, Fresta M. Lecithin micro-emulsions for the topical administration of ketoprofen: percutaneous absorption through human skin and in vivo human skin tolerability. Int J Pharm. 2002;244(1-2):21-31.
25. Montastier P, Poiraud T, Poelman MC. Etude de la cinetique de diffusion in vitro de quatre AINS destines a la voie percutanee. Medicine du Sport. 1994;68:40-42.
26. Rolf C, Engström B, Beauchard C, Jacobs LD, Le Liboux A. Intra-articular absorption and distribution of ketoprofen after topical plaster application and oral intake in 100 patients undergoing knee arthroscopy. Rheumatology (Oxford). 1999;38(6):564-567.
27. Radermacher J, Jentsch D, Scholl MA, Lustinetz T, Frolich JC. Diclofenac concentrations in synovial fluid and plasma after cutaneous application in inflammatory and degenerative joint disease. Br J Clin Pharmacol. 1991;31(5):537-541.
28. Gallacchi G, Marcolongo R. Pharmacokinetics of diclofenac hydroxyethylpyrrolidine (DHEP) plasters in patients with monolateral knee joint effusion. Drugs Exp Clin Res. 1993;19(3):95-97.
29. Mason L, Moore RA, Edwards JE, Derry S, McQuay HJ. Topical NSAIDs for acute pain: a meta-analysis. BMC Fam Pract. 2004;5:10.
30. Moore RA, Tramér MR, Carroll D, Wiffen PJ, McQuay HJ. Quantitative systematic review of topically applied non-steroidal anti-inflammatory drugs. BMJ. 1998;316(7128):333-338.
31. Galer BS, Rowbotham M, Perander J, Devers A, Friedman E. Topical diclofenac patch relieves minor sports injury pain: results of a multicenter controlled clinical trial. J Pain Symptom Manage. 2000;19(4):287-294.
32. Rowbotham MC, Galer BS, Block JA, Backonja MM. Flector Tissugel: efficacy and safety in the treatment of minor sports injuries. Data from a controlled trial in the United States. J Traumatol Sport. 2003;20:1S15-1S20.
33. Gallacchi G, Frentzel A, Heidecker JL. Topical treatment of blunt-impact soft tissue injuries [in German]. Praxis (Bern 1994). 2003;92(51-52):2201-2207.
34. Rovati S, Lanzarotti A, Yanchick J, Magelli M, Fuller C. Timing of effect of diclofenac epolamine topical patch 1.3% (FLECTOR Patch) in the treatment of pain due to osteoarthritis of the knee. Arch Phys Med Rehabil. 2009;89(11):e1.
35. Brühlmann P, Michel BA. Topical diclofenac patch in patients with knee osteoarthritis: a randomized, double-blind, controlled clinical trial. Clin Exp Rheumatol. 2003;21(2):193-198.
36. Brühlmann P, de Vathaire F, Dreiser RL, Michel BA. Short-term treatment with topical diclofenac epolamine plaster in patients with symptomatic knee osteoarthritis: pooled analysis of two randomised clinical studies. Curr Med Res Opin. 2006;22(12):2429-2438.
37. Dreiser RL, Tisne-Camus M. DHEP plasters as a topical treatment of knee osteoarthritis - a double-blind placebo-controlled study. Drugs Exp Clin Res. 1993;19(3):117-123.
38. Jenoure PJ, Rostan A, Gremion G, et al. Multicenter, double-blind, controlled clinical sutdy of diclofenac Tissugel plaster in patients with epicondylitis. Med Sport (Roma). 1997;50(3):285-292.
39. Rosenthal M, Bahous I. A controlled clinical study on the new topical dosage form of DHEP plasters in patients suffering from localized inflammatory diseases. Drugs Exp Clin Res. 1993;19(3):99-105. (Pubitemid 24000676)
40. Altman RD, Dreiser RL, Fisher CL, Chase WF, Dreher DS, Zacher J. Diclofenac sodium gel in patients with primary hand osteoarthritis: a randomized, double-blind, placebo-controlled trial. J Rheumatol. 2009;36(9):1991-1999.
41. Barthel HR, Haselwood D, Longley S 3rd, Gold MS, Altman RD. Randomized controlled trial of diclofenac sodium gel in knee osteoarthritis. Semin Arthritis Rheum. 2009;39(3):203-212.
42. Towheed TE. Pennsaid therapy for osteoarthritis of the knee: a systematic review and metaanalysis of randomized controlled trials. J Rheumatol. 2006;33(3):567-573.
43. Tugwell PS, Wells GA, Shainhouse JZ. Equivalence study of a topical diclofenac solution (pennsaid) compared with oral diclofenac in symptomatic treatment of osteoarthritis of the knee: a randomized controlled trial. J Rheumatol. 2004;31(10):2002-2012.
44. Roth SH, Shainhouse JZ. Efficacy and safety of a topical diclofenac solution (pennsaid) in the treatment of primary osteoarthritis of the knee: a randomized, double-blind, vehicle-controlled clinical trial. Arch Intern Med. 2004;164(18):2017-2023.
45. Predel HG, Koll R, Pabst H, et al. Diclofenac patch for topical treatment of acute impact injuries: a randomised, double blind, placebo controlled, multicentre study. Br J Sports Med. 2004;38(3):318-323.
46. Campbell J, Dunn T. Evaluation of topical ibuprofen cream in the treatment of acute ankle sprains. J Accid Emerg Med. 1994;11(3):178-182.
47. Trnavsky K, Fischer M, Vögtle-Junkert U, Schreyger F. Efficacy and safety of 5% ibuprofen cream treatment in knee osteoarthritis. Results of a randomized, double-blind, placebo-controlled study. J Rheumatol. 2004;31(3):565-572.
48. Underwood M, Ashby D, Cross P, et al. Advice to use topical or oral ibuprofen for chronic knee pain in older people: randomised controlled trial and patient preference study. BMJ. 2008;336(7636):138-142.
49. Machen J, Whitefeld M. Efficacy of a proprietary ibuprofen gel in soft tissue injuries: a randomized, double-blind placebo-controlled study. Int J Clin Pract. 2002;56(2):102-106.
50. Whitefield M, O'Kane CJ, Anderson SD. Comparative efficacy of a proprietary topical ibuprofen gel and oral ibuprofen in acute soft tissue injuries: a randomized, double-blind study. J Clin Pharm Ther. 2O02;27(6):409-417.
51. Mazières B. Topical ketoprofen patch. Drugs R D. 2005;6(6):337-344.
52. Rother M, Lavins BJ, Kneer W, Lehnhardt K, Seidel EJ, Mazgareanu S. Efficacy and safety of epicutaneous ketoprofen in Transfersome (IDEA-033) versus oral celecoxib and placebo in osteoarthritis of the knee: multicentre randomised controlled trial. Ann Rheum Dis. 2007;66(9):1178-1183.
53. Stucki G, Rother M, for the European IDEA-033 Study Group. Randomized, double-blind, placebo-controlled study of three dosages of epicutaneously applied IDEA-033 (Keteprofen in Transfersome) in patients with osteoarthritis of the knee [abstract]. Ann Rheum Dis. 2007;66(suppl II):510.
54. Stucki G, Rother M. Epicutaneously applied Diractin® (ketoprofen in Transfersome) in patients with osteoarthritis (OA) of the knee-results of a 24-week study. Abstract presented at: Annual European Congress of Rheumatology (EULAR); June 11-14, 2008; Paris, France.
55. Rother M, Rother I, Mazgareanu S. Local treatment of muscle damage using Diractin® (ketoprofen in Transfersome®). Abstract presented at: Annual European Congress of Rheumatology (EULAR); June 11-14, 2008; Paris, France.
56. Vaile JH, Davis P. Topical NSAIDs for musculoskeletal conditions. A review of the literature. Drugs. 1998;56(5):783-799.
57. Boelsterli UA. Diclofenac-induced liver injury: a paradigm of idiosyncratic drug toxicity. Toxicol Appl Pharmacol. 2003;192(3):307-322.
58. Yanchick J, Sun S, Pirovano P. Safety of diclofenac epolamine topical patch 1.3% evaluated in clinical trials and postmarketing surveillance. Poster presented at: International Association for the Study of Pain (IASP) 12th World Congress on Pain; August 17-22, 2008; Glasglow, Scotland.
59. Zimmerman J, Siguencia J, Tsvang E. Upper gastrointestinal hemorrhage associated with cutaneous application of diclofenac gel. Am J Gastroenterol. 1995;90(11):2032-2034.
60. Registered Nurses Association of Ontario. Assessment of Management and Pain. Toronto, Ontario. November 2002; Updated February 2007. http://www.rnao.org/Page.asp?PageID=924&ContentID=720. Accessed April 26, 2010.