Advice to use topical or oral ibuprofen for chronic knee pain in older people: Randomised controlled trial and patient preference study

Centre for Health Sciences, Barts and The London, Queen Mary, University of London, London E1 2AT.
BMJ (online) (Impact Factor: 17.45). 01/2008; 336(7636):138-42. DOI: 10.1136/bmj.39399.656331.25
Source: PubMed


To determine whether older patients with chronic knee pain should be advised to use topical or oral non-steroidal anti-inflammatory drugs (NSAIDs).
Randomised controlled trial and patient preference study.
26 general practices.
People aged > or =50 with knee pain: 282 in randomised trial and 303 in preference study.
Advice to use topical or oral ibuprofen. Primary outcome measures WOMAC (Western Ontario and McMaster Universities) osteoarthritis index, major and minor adverse effects.
Changes in global WOMAC scores at 12 months were equivalent. In the randomised trial the difference (topical minus oral) was two points (95% confidence interval -2 to 6); in the preference study, it was one point (-4 to 6). There were no differences in major adverse effects in the trial or study. The only significant differences in secondary outcomes were in the randomised trial. The oral group had more respiratory adverse effects (17% v 7%,95% confidence interval for difference -17% to -2%), the change in serum creatinine was 3.7 mmol/l less favourable (0.9 micromol/l to 6.5 micromol/l); and more participants changed treatments because of adverse effects (16% v 1%, -16% to -5%). In the topical group more participants had chronic pain grade III or IV at three months, and more participants changed treatment because of ineffectiveness.
Advice to use oral or topical preparations has an equivalent effect on knee pain over one year, and there are more minor side effects with oral NSAIDs. Topical NSAIDs may be a useful alternative to oral NSAIDs.
ISRCTN 79353052.

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    • "In the context of a randomised trial comparing treatments for knee OA, three studies reported patients' preferences for the treatments implemented. Underwood et al. (2007) offered patients the possibility of participating in a randomised trial or a preference study comparing topical versus oral ibuprofen for chronic knee pain. Among those who decided to participate in the preference study, 74% opted for the topical modality of the drug. "

    Full-text · Chapter · Mar 2012
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    • "However, the larger, more rigorous trials have tended to be negative. A recent study suggests topical ibuprofen may also be beneficial for knee OA [52]. "
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