Systematic review: acute musculoskeletal pain relief with topical diclofenac

  • Wiffen PJ & al.
  • Curr Med Res Opin
  • 16 Jan 2020

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Topical diclofenac is significantly more effective than placebo in reducing acute pain caused by sprains, strains, and musculoskeletal injuries, with gel formulations offering greater pain relief than plaster formulations.
  • These findings are from a large systematic review of more than 11,000 patients in 44 studies.
  • Topical diclofenac is also effective in reducing chronic pain from osteoarthritis and other musculoskeletal conditions, although more modestly so.

Why this matters

  • Topical NSAID use varies worldwide, and opinions are mixed about their pain relief effectiveness.

Study design

  • This systematic review assessed the efficacy and safety of topically applied diclofenac in acute (23 studies; n=5170) and chronic (21 studies; n= 5995) musculoskeletal pain in adults.
  • Funding: None disclosed.

Key results

  • In patients with acute pain, the number needed to treat (NNT) in different formulations vs placebo:
    • Diclofenac Flector plaster: 4.7 (95% CI, 3.7-6.5).
    • Diclofenac plaster with heparin: 7.44 (95% CI, 4.61-19.23).
    • Voltaren Emulgel: 1.8 (95% CI, 1.5-2.1).
  • Diclofenac gel formulation was more efficacious than the Flector plaster formulation in acute pain (P<.00001>
  • In patients with chronic pain, diclofenac gel/solution had a modest benefit with an NNT of 9.5 (95% CI, 7-14.7).

Limitations

  • The reporting of adverse events was poor.

Coauthored with Chitra Ravi, MPharm