Multidisciplinary Guidelines for the Rational Use of Topical Non-Steroidal Anti-Inflammatory Drugs for Musculoskeletal Pain (2022)

Abstract

(1) Background: Topical non-steroidal anti-inflammatory drugs (NSAIDs) are one of the primary drugs for treating musculoskeletal pain. However, there are currently no evidence-based recommendations about drug selection, drug administration, drug interactions, and use in special populations or other pharmacology-related content of such medications. To this end, the Chinese Pharmaceutical Association Hospital Pharmacy Professional Committee developed multidisciplinary guidelines on using topical NSAIDs to treat musculoskeletal pain. (2) Methods: The guidelines development process followed the World Health Organization guideline development handbook, the GRADE methodology, and the statement of Reporting Items for Practice Guidelines in Healthcare. The guideline panel used the Delphi method to identify six clinical questions to be addressed in the guidelines. An independent systematic review team conducted a systematic search and integration of evidence. (3) Results: Based on the balance between the benefits and harms of an intervention, the quality of the evidence, patient preferences and values, and resource utilization, the guideline panel developed 11 recommendations and nine expert consensuses on using topical NSAIDs to treat acute and chronic musculoskeletal pain. (4) Conclusions: Based on the effectiveness and overall safety of topical NSAIDs, we recommend patients with musculoskeletal pain use topical NSAIDs and suggest high-risk patients use topical NSAIDs, such as those with other diseases or receiving other concurrent treatments. The evidenced-based guidelines on topical NSAIDs for musculoskeletal pain incorporated a pharmacist perspective. The guidelines have the potential to facilitate the rational use of topical NSAIDs. The guideline panel will monitor the relevant evidence and update the recommendations accordingly.

Efficacy and Safety of Loxoprofen Sodium Hydrogel Patch in Patients with Chronic Inflammatory Pain: A 4-Week Real-World Study

“…23 Recently published evidence-based guidelines for topical NSAIDs for musculoskeletal pain have also indicated no statistically significant difference in the risk of adverse events with topical NSAIDs compared with placebo. 3 We have found the excellent practicability of LX-P from a number of randomized controlled trials, and this study is the earliest RWS. However, this study had some limitations.…”

“…1,2 Chronic inflammatory pain tends to have a low age of onset and significantly increases the medical and economic burden of patients, which can markedly reduce the quality of life without timely intervention. 3 According to the United Kingdom Health and Safety Executive, 5.7 million working days were lost between 2001 and 2002 due to low back pain, whereas 4.1 million working days were lost due to upper limb, neck, and shoulder pain, resulting in an annual economic loss of approximately £5.7 billion. 4 In China, the years of living with disability increased dramatically from 17.6 million to 28.1 million between 1990 and 2019.…”

Efficacy and Safety of Muscle Rub Ointment in The Management of Arthritis and Certain Musculoskeletal Disorders

“…Honeybees use beeswax to construct a comb, which is then filled with hexagonal cells that hold honey and developing larvae. Beeswax has been investigated for its potential medicinal uses, and preliminary results suggest that it may have a slight anti-inflammatory impact and be helpful for pain relief (Shi et al, 2023).…”

Multidisciplinary Management of the Patient with Knee Endoprosthetics. A Case Report

“…The synovial fluid in OA has been found to contain several inflammatory mediators, such as leukotrienes (LKB4), growth factors (VEGF, TGFß, NGF, and FGFs), plasma proteins (C-reactive protein), cytokines (IL1β , IL6, IL15, IL17, IL18, IL21 and TNF), complement components, nitric oxide and prostaglandins. 9,10 All of the components mentioned above are capable of generating MMP, as well as certain hydrolytic enzymes (including prostaglandin E and cyclooxygenases) at the local level, which causes damage to collagen and proteoglycans and results in the destruction of cartilage. The immune system cells (mast cells and macrophages) identify certain molecules (molecular models associated with damage) formed during the destruction of the extracellular matrix, which determines the action of leukocytes in the protection process.…”

“…For this reason, the pain has mainly been caused by changes in non-cartilaginous components of the joint, such as ligaments, the subchondral bone, the joint capsule, periarticular muscles, and the synovial membrane. 9 As the disease progresses, these parts get damaged, weakening the periarticular muscles, bone remodeling, synovial effusion, weakening of ligaments, and formation of osteophytes. 10 Conservative treatment of knee osteoarthritis: Currently, there are many conservative methods of treating primary knee joint osteoarthritis in middle-aged patients, which contribute to improving and slowing the disease progression.…”