Article type
Year
Abstract
Introduction: Evidence on the efficacy of NSAIDs for shoulder complaints is scarce. Nevertheless, therapy is frequently initiated with the prescription of NSAIDs.
Objective: To evaluate the medical literature with respect to the efficacy of NSAIDs for shoulder complaints.
Methods: The search strategy included a MEDLINE literature search of the period 1966-1993 and citation tracking of all relevant publications. 19 randomized trials met the selection criteria and were included in this review. Each publication was independently scored by two blinded reviewers, according to 17 standardized methodological criteria. The studies were ranked according to their total methods score (maximum 100 points).
Results: The methodological quality of most studies was disappointing; only 5 trials received a methods score exceeding 50 points. Furthermore, information regarding methodological criteria was often inadequately described, particularly regarding the randomization procedure, co-interventions and control of compliance. The three trials with the highest scores demonstrated superior short-term efficacy of NSAIDs in comparison with placebo intervention. 14 trials comparing two types of NSAIDs showed no conclusive evidence in favour of a particular NSAID with respect to efficacy or tolerability. Power calculations showed that only three trials had sufficient power to detect a clinically relevant difference in success rate of 25%.
Discussion: Future studies should compare the benefit-risk ratios of NSAIDs and analgesics for shoulder complaints in order to establish whether the use of NSAIDs is more favourable than analgesics, despite the higher risk of adverse reactions from NSAIDs.
Objective: To evaluate the medical literature with respect to the efficacy of NSAIDs for shoulder complaints.
Methods: The search strategy included a MEDLINE literature search of the period 1966-1993 and citation tracking of all relevant publications. 19 randomized trials met the selection criteria and were included in this review. Each publication was independently scored by two blinded reviewers, according to 17 standardized methodological criteria. The studies were ranked according to their total methods score (maximum 100 points).
Results: The methodological quality of most studies was disappointing; only 5 trials received a methods score exceeding 50 points. Furthermore, information regarding methodological criteria was often inadequately described, particularly regarding the randomization procedure, co-interventions and control of compliance. The three trials with the highest scores demonstrated superior short-term efficacy of NSAIDs in comparison with placebo intervention. 14 trials comparing two types of NSAIDs showed no conclusive evidence in favour of a particular NSAID with respect to efficacy or tolerability. Power calculations showed that only three trials had sufficient power to detect a clinically relevant difference in success rate of 25%.
Discussion: Future studies should compare the benefit-risk ratios of NSAIDs and analgesics for shoulder complaints in order to establish whether the use of NSAIDs is more favourable than analgesics, despite the higher risk of adverse reactions from NSAIDs.