Similar outcomes for topical and oral ibuprofen
Patients with knee pain who are advised to use either oral or topical ibuprofen, or who make the choice themselves, record similar benefit after 12-months, but those patients using topical treatment are more likely to be prescribed oral anti-inflammatories as well, a BMJ study reveals (2008;336:138).
A second, related, study (ibid, p142) suggests that patients’ choices between topical and oral non-steroidal anti-inflammatory drugs tend to be logical and appropriate.
In the first study, patients over 50 years of age with chronic knee pain were invited to take part in either a randomised trial (where they were advised to take oral ibuprofen or topical ibuprofen; n=282) or a preference trial (where patients chose oral or topical administration; n=303). At one year there was no significant difference between any of the groups in terms of changes in pain and disability scores from baseline. However, in the topical group more participants had severe chronic pain at three months. Medical records revealed that over a quarter of patients who chose to be treated topically and over a third of patients who were assigned to topical treatment were also prescribed oral anti-inflammatories during the study.
In the randomised trial, more patients in the topical group reported changing their treatment because of inadequate pain relief than in the oral group, and more patients in the oral group reported changing treatment due to side effects. These trends were not seen in the preference trial.
The second study looked at the rationale behind patients’ decisions to take part in
either of the two trials and 30 patients were interviewed. The authors suggest that choice of topical or oral treatment depends on the nature of the pain, patients’ perceived risk of side effects, medical advice and practicalities.
In an accompanying editorial (ibid, p105), Paul Dieppe, Nuffield Department of Orthopaedic Surgery, University of Oxford, says: “The results from the preference data are fascinating. Firstly, more people chose the preference study than the randomised controlled trial, and nearly three times more of them opted for the topical preparation (n=224) than the oral preparation (n=79). . . . Another intriguing finding was that adverse events after oral ibuprofen occurred less often in participants who chose tablets than in those who were randomised to them.”
He suggests that, given options, patients will make sensible choices about how they want to be treated, and that their ability to choose may improve efficacy and reduce toxicity.
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