- 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.
- 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.
- 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).
- The reporting of adverse events was poor.
Coauthored with Chitra Ravi, MPharm