"The story says that the average copayment for a month’s supply of some of the topical NSAID medications is around $30. It would have been nice to include the cost of comparable oral medications. Although the story explains the available evidence comparing topical NSAIDs to oral pain relievers, highlights the limited number of direct comparisons, and carefully states the general consensus of experts, all of this solid reporting is undermined by a focus on personal anecdotal evidence over quantifiable benefits. Indeed, the reporter claims one medication provided immediate relief, a statement at odds with clinical trials that conclude that it usually takes hours for patients to feel the pain-relief effects of topical NSAIDs. The story summarizes the reported side effects of topical NSAIDS. What’s more, the reporter points out that the potential risks in people who have other health problems or are taking other drugs have not been well studied. That insight is something we see too rarely. The story refers to a number of clinical trials and systematic reviews of the evidence. It highlights areas where evidence is lacking or inconclusive. It would have been helpful to point out that in placebo-controlled trials, almost as many people who received the placebo reported pain relief as did those who got the active medication. The story could have mentioned that the systematic review it referred to was published by the Cochrane Collaboration and also the sources of the other clinical trial reports, so that interested readers could more easily locate the original articles. The story does not exaggerate the common pains these drugs are intended to treat, but the personal anecdotes and opinions highlighted at the beginning and ending of the story are unrepresentative of the typical experiences reported by participants in clinical trials and create a powerful impression that is at odds with the evidence. The story includes quotes from several experts and points out that two of them have accepted consulting fees or research support from pharmaceutical companies. The essence of this story is an attempt to compare topical NSAIDs with pills and other pain treatments. As noted above, though, the story does not mention that most people with minor pains feel better after awhile even if they don’t take any pain relief medication. It also should have mentioned that the difference between placebo and active treatment groups in the clinical trials is often slim. The story reports that only three topical NSAIDs (nonsteroidal anti-inflammatory drugs) are approved for sale with a prescription in the United States, while several brands are sold over the counter in Europe. Part of the focus of the story is that NSAIDS have been around for a long time but only recently are being given a more serious scientific reassessment. As the story says, ""But a number of new controlled trials and meta-analyses like Dr. Moore’s suggest that topical Nsaids are as effective as their oral counterparts for treating osteoarthritis in the knee and hand as well as musculoskeletal injuries like soreness and tendinitis."" The story includes several experts and mentions multiple studies."
Topical Gel Catches Up With Pills for Relief