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Topical NSAIDs Are Effective for Tennis Elbow Without Oral Side Effects
Full Title
Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults.
Summary
This Cochrane systematic review analyzed 15 trials with 759 participants to evaluate the effectiveness of topical and oral NSAIDs for treating lateral elbow pain, commonly known as tennis elbow. The review found that topical NSAIDs were significantly more effective than placebo for short-term pain relief, with a number needed to treat of 7, meaning that for every 7 patients treated with topical NSAIDs, one additional patient experienced significant pain relief compared to placebo. Participants using topical NSAIDs also reported better overall treatment effectiveness at 28 days. Adverse effects from topical NSAIDs were minimal, with only mild skin reactions such as rash reported in 2.5% of users, compared to 1.3% with placebo. For oral NSAIDs, the evidence was conflicting. One trial found significant pain improvement compared to placebo while another found no difference, and neither showed improvement in function. Notably, oral NSAIDs were associated with an increased risk of gastrointestinal side effects, and several participants had to discontinue treatment due to GI issues. The review found no trials that directly compared topical and oral NSAIDs head to head. These findings support the use of topical NSAIDs as a first-line option for conditions like tennis elbow, where the anti-inflammatory medication can be delivered directly to the injured tendon without exposing the gastrointestinal system to the risks associated with oral NSAIDs. For patients who do use oral NSAIDs, the evidence suggests limiting duration to the short term.