As a clinician or exercise professional, you have encountered many acute musculoskeletal injuries. You have always advised your patient/ client to take non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (e.g. Nurofen) or diclofenac (e.g. Voltaren) to reduce pain. Now you have a client who has sustained an acute ankle injury while playing soccer. This client does not like taking medication and asks whether they could use NSAID creams or gels instead. You have colleagues who believe these treatments to be a waste of time, but you have never checked the literature to confirm this. Find the best available evidence to inform you as to whether topical NSAID treatments can reduce pain for acute injuries.
Non steroidal anti-inflammatory drugs or NSAIDs are the steroid free clinical option for various problems faced in the modern life. These anti-inflammatory drugs are normally used due to their “analgesic” or “pain relieving” effects (Greener, 2009). NSAIDs that are now almost common in most households are aspirin (acetylsalicylic acid), ibuprofen and diclofenac. The major delivery over the last decade of NSAIDs has been via oral treatments and medications. However, recent studies have shown that topical treatments may provide a better health outcome when it comes to pain relief and general health (Greener, 2009).
Though these drugs have seen a lot of success over the last few decades, various studies have highlighted major toxicological side effects from high dosages of NSAIDs. A recent review conducted by McCarbeg (2010) found that doses higher than 2g/day of oral NSAIDs lead to higher risk of gastrointestinal complications. These oral NSAIDs are also being blamed for causing a higher risk in development of cardiovascular diseases such as hypertension. McCarbeg (2010) conducted a review on an a blind study that tested the gastric erosions that occurred at the delivery of different oral NSAIDs compared to a placebo. The study found that ibuprofen and aspirin had almost 10 times more gastrointestinal erosion when compared to subjects that were given the placebo. In the same review, McCarbeg (2010) highlights that various American government bodies prohibit the use of NSAIDs if the patient suffers from cardiovascular diseases.
Oral delivery of non-steroidal anti-inflammatory drugs has been part of a controversial debate for long period of time. The main reason behind the support of continuing delivery of oral NSAIDs is the level of pain relief that is achieved. A randomised controlled trial and a patient preference study conducted by the Centre of Health Sciences, University of London (Underwood, 2009) found that patients who were given the topical treatment were “more likely to have overall pain.....and were more likely to report changing treatment because of inadequate pain relief”(Underwood, 2009). However, same randomised control trial found that patients undergoing topical NSAIDs treatments were less likely to suffer adverse renal and cardiovascular effects(Underwood, 2009).
Topical NSAIDs are said to be the alternative option for patients that suffer from cardiovascular and GI tract diseases. A clinical summary conducted by Mark Greener (2009) looks at studies and systematic reviews that highlight the recent success and efficacy of topical NSAIDs. Greener (2009) concludes that research studies and controlled trails have now provided enough evidence in support of the use of topical NSAIDs over its oral counterparts. Greener highlights that “topical NSAIDs are clinically affective against chronic and acute pain” (Greener, 2009) and presents the idea that topical treatment is a viable solution for treating patients.
NSAIDs provide a viable 'over-the-counter' solution to various acute injuries. However, education and management of the right treatment is critical to establishing a healthier outcome for the client. Questions that need to be discussed include whether the client requires substantial...
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