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Topical ibuprofen advisable
for knee pain
Research in UK general practice has shown that older patients with knee
pain should normally be advised to use topical rather than oral ibuprofen.
But for those who prefer oral treatment or have pain elsewhere, oral administration
remains a reasonable option.(1)
Until now, it has not been certain whether oral or topical treatment was
better. The study, part of the prestigious NHS research programme, was
carried out to clarify how GPs should advise their patients to treat knee
pain. The GP could either prescribe treatment or advise the patient to
buy the medicine over the counter.
There were two parts. In a randomised controlled trial, 282 people were
assigned treatment with oral ibuprofen up to 1200 mg/day or topical ibuprofen
at a dose of 1.5 g of gel or cream three times a day. In the second part
(a patient preference study), patients chose which form of treatment they
wanted - oral or topical.
After one and two years' treatment, there was no difference between oral
and topical ibuprofen in reducing pain, stiffness or physical function
or overall effects in either part of the study. In the randomised trial,
there were slightly more adverse events affecting the respiratory system
and kidney function with oral administration but this was not observed
in the patient preference study.
One interesting finding was that people who knew little about their knee
pain and how their treatment worked were more likely to put up with symptoms.
The authors suggest they could therefore be at greater risk of side effects.
Overall, the authors concluded that oral administration of ibuprofen is
associated with more minor side effects than topical application, so older
people with knee pain should generally be advised to try this first. But
the differences between the treatments is not great, so oral administration
is reasonable for patients who prefer it - provided they are warned of
possible side effects.
Reference
1. Underwood M, Ashby D, Carnes D et al. Topical or oral ibuprofen for
chronic knee pain in older people. The TOIB study. Health Technology Assessment
2008;12:No. 22
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