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Topical NSAIDs Appear to be Effective at Decreasing Pain without Systemic Side Effects

Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used to decrease pain and inflammation. Many of these medicines are available over the counter in pill form and are generally considered safe, but there are some side effects to be concerned about. NSAIDs in pill form can increase the risk of stomach problems, ulcers, and in extreme cases can interfere with kidney function. Topical NSAIDs (cream, gel, spray) are another form of NSAIDs that are not as widely available in all countries. Recently, more attention has been put on these medicines due to the idea that they would have a more local effect and therefore not as many side effects. Targeting treatment to the specific area may decrease systemic issues related to oral NSAIDs while still providing pain relief.

Researchers from Cochrane Database created a systematic review of trials reviewing pain relief and adverse events in patients with acute pain. The trial found that topical NSAIDs are safe and effective for acute pain relief in adults.

About the Study

The systematic review included 47 randomized trials that assessed topical NSAIDs for the treatment of acute pain from sprains, strains, or sports overuse injuries. The trials included 3,455 adults. The treatment was considered successful if there was greater than 50% reduction in pain. The trials, matched by outcomes and/or specific items studied, showed that:

  • Topical NSAIDs had greater success in pain reduction than placebo at 6-14 days in 31 trials
  • Many different types of topical NSAIDs (diclofenac, ibuprofen, ketoprofen, and piroxicam) were effective
  • Topical NSAIDs had systemic adverse events (ulcers, stomach problems, kidney problems) similar to those reported with placebo
  • Skin reactions in the application area of NSAIDs were mild and did not differ from placebo

There was not enough evidence in the trials to be able to directly compare topical NSAIDs with oral NSAIDs.

How Does This Affect You?

A systematic review can provide reliable outcomes by grouping large numbers of trials and comparing the results. The quality of the studies in the review need to be considered to assess the quality of the results from the systematic review. There were some statistical problems when combining these studies that could impact the intensities of the outcomes, but the overall results seem to support the use of topical NSAIDs.

In the United States, topical NSAIDs are not as popular as they are in other parts of the world. In other parts of the world, some types can be obtained without a prescription. In the United States, you can get them with a prescription from your doctor. If you do not tolerate oral NSAIDs well, you may want to discuss topical NSAIDs with your doctor. Hopefully with all the positive research into topical NSAIDs, they will become more widely accessible.




  • Massey T, Derry S, Moore RA, McQuay HJ. Topical NSAIDs for acute pain in adults. Cochrane Database of Systematic Reviews 2010, Issue 6. Art. No.: CD007402.

Last reviewed November 2010 by Brian P. Randall, MD

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