Research published by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme has found that non-steroidal anti-inflammatory (NSAIDs) creams is as effective as tablets for the treatment of chronic knee pain in older people. Currently both topical and oral NSAID preparations of drugs like ibuprofen, naproxen and diclofenac, are used to treat knee pain. NSAIDs, however, are associated with gastrointestinal, cardiovascular and respiratory adverse effects, which are a particular risk for older people. Topical preparations should produce fewer side effects and so could be a good alternative treatment for this group of people.
Researchers from Queen Mary University of London, led by Professor Martin Underwood, now based at the University of Warwick, recruited 585 people aged 50 or over from 26 general practices in the Medical Research Council General Practice Research Framework across the UK, to compare the clinical and cost-effectiveness of oral with topical NSAIDs for the treatment of chronic knee pain. They also looked at patients' preferences and their attitudes towards the adverse side effects associated with the treatments, as this can influence perception on the effectiveness of the medication.
The results showed that topical NSAIDs have an equivalent effect to oral NSAID on chronic knee pain in older people, and that those treated with oral preparations had more minor adverse effects such as indigestion, increased blood pressure, or worsening asthma. However participants with more severe widespread pain preferred oral rather than topical medication, as they believed it might help other areas of pain whilst circulating around the body.
"Chronic knee pain is a common problem in older people and until now there has been little evidence to suggest which form of medication, either topical or oral is the most effective," says Professor Underwood. "The results of our research suggest that advising older people with chronic knee pain to use topical rather than oral NSAIDs could be appropriate, although for those who would prefer oral preparations this is still a reasonable treatment option. These results will help GPs and their patients decide on whether topical or oral NSAIDs are the best choice for them"
The report published in Health Technol Assess 2008; Vol. 12:22 to view or download the full report visit hta.ac.uk/1302
1. The HTA programme is a programme of the National Institute for Health Research (NIHR) and produces high quality research information about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest of the NIHR programmes and publishes the results of its research in the Health Technology Assessment journal, with over 400 issues published to date. The journal's 2006 Impact Factor (5.29) ranked it in the top 10% of medical and health-related journals. All issues are available for download free of charge from the website, hta.ac.uk The HTA programme is coordinated by the National Coordinating Centre for Health Technology Assessment (NCCHTA), based at the University of Southampton.
2. The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients.
National Institute for Health Research
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