PMID- 31944135
OWN - NLM
STAT- MEDLINE
DCOM- 20210322
LR  - 20210322
IS  - 1473-4877 (Electronic)
IS  - 0300-7995 (Linking)
VI  - 36
IP  - 4
DP  - 2020 Apr
TI  - Systematic review of topical diclofenac for the treatment of acute and chronic 
      musculoskeletal pain.
PG  - 637-650
LID - 10.1080/03007995.2020.1716703 [doi]
AB  - Aim: The objective was to systematically review the efficacy and safety of 
      topical diclofenac in both acute and chronic musculoskeletal pain in 
      adults.Methods: We used standard Cochrane methods. Searches were conducted in 
      MEDLINE, EMBASE and The Cochrane Register of Studies; date of the final search 
      was November 2018. Included studies were randomized, double blinded, with ten or 
      more participants per treatment arm. The primary outcome of "clinical success" 
      was defined as participant-reported reduction in pain of at least 50%. Details of 
      adverse events (AEs) were recorded.Results: For acute pain, 23 studies (5170 
      participants) were included. Compared to placebo, number needed to treat (NNT) 
      for different formulations were as follows: diclofenac plaster, 4.7 (95% CI 
      3.7-6.5); diclofenac plaster with heparin, 7.4 (95% CI 4.6-19); and diclofenac 
      Emulgel, 1.8 (95% CI 1.5-2.1). 4.1% (78/1919) reported a local AE. For chronic 
      pain, 21 studies (26 publications) with 5995 participants were included. 
      Formulations included gel, solution with or without DMSO, emulsion and plaster. A 
      clinical success rate of  approximately 60% (NNT 9.5 [95% CI 7-14.7]) was achieved with a 
      variety of formulations. Local AEs ( approximately 14%) were similar for both diclofenac and 
      placebo.Conclusion: This systematic review of 11,000+ participants demonstrates 
      that topical diclofenac is effective for acute pain, such as sprains, with 
      minimal AEs. The effectiveness of topical diclofenac was also demonstrated in 
      chronic musculoskeletal pain but with a higher NNT (worse) compared with acute 
      pain. Formulation does play a part in effectiveness but needs further studies.
FAU - Wiffen, Philip J
AU  - Wiffen PJ
AUID- ORCID: 0000-0001-6085-1307
AD  - Pain Research Unit, Churchill Hospital, Oxford University Hospitals, Oxford, UK.
FAU - Xia, Jun
AU  - Xia J
AUID- ORCID: 0000-0002-6823-4757
AD  - The Nottingham China Health Institute, The University of Nottingham Ningbo, 
      Ningbo, Zhejiang, China.
LA  - eng
PT  - Journal Article
PT  - Systematic Review
DEP - 20200203
PL  - England
TA  - Curr Med Res Opin
JT  - Current medical research and opinion
JID - 0351014
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 144O8QL0L1 (Diclofenac)
SB  - IM
MH  - Acute Pain/*drug therapy
MH  - Administration, Topical
MH  - Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
MH  - Chronic Pain/*drug therapy
MH  - Diclofenac/*administration & dosage
MH  - Humans
MH  - Musculoskeletal Pain/*drug therapy
MH  - Randomized Controlled Trials as Topic
OTO - NOTNLM
OT  - NSAID
OT  - Systematic review
OT  - acute pain
OT  - chronic pain
OT  - diclofenac
OT  - topical NSAID
EDAT- 2020/01/17 06:00
MHDA- 2021/03/23 06:00
CRDT- 2020/01/17 06:00
PHST- 2020/01/17 06:00 [pubmed]
PHST- 2021/03/23 06:00 [medline]
PHST- 2020/01/17 06:00 [entrez]
AID - 10.1080/03007995.2020.1716703 [doi]
PST - ppublish
SO  - Curr Med Res Opin. 2020 Apr;36(4):637-650. doi: 10.1080/03007995.2020.1716703. 
      Epub 2020 Feb 3.