Topical therapies

NSAID creams and gels

One systematic review of 86 clinical trials comparing topically applied NSAIDs with placebo found these agents had a relative benefit of 2.0 (95 percent confidence interval (CI) 1.5-2.7) for relief of chronic musculoskeletal pain caused by OA and tendonitis.107[I] Topical NSAIDs have a good safety record. Large surveillance studies in general practice suggest good safety (adverse events < 1.5 percent) with local skin reactions the principal side effect with no association between topical NSAIDs and upper gastrointestinal bleeding or perforation.108[III]

Capsaicin cream

A nonsystematic meta-analysis of pooled data from three RCTs of topically applied capsaicin concluded that it was useful for pain relief.109[IV] Active treatment with cap-saicin results in significantly greater pain reduction than placebo.110[II] Capsaicin may cause a mild, transient, burning sensation.

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