Formulations of topical diclofenac, ibuprofen, ketoprofen, piroxicam, and indomethacin demonstrated significantly higher rates of clinical success (more participants with at least 50% pain relief) than matching topical placebo (moderate or high quality data ). Benzydamine did not. Three drug and formulation combinations had NNTs for clinical success below 4. For diclofenac, the Emulgel® formulation had the lowest NNT of (95% CI to ) in two studies using at least 50% pain intensity reduction as the outcome . Diclofenac plasters other than Flector® also had a low NNT of ( to ) based on good or excellent responses in some studies. Ketoprofen gel had an NNT of ( to ), from five studies in the 1980s, some with less well defined outcomes. Ibuprofen gel had an NNT of ( to ) from two studies with outcomes of marked improvement or complete remission. All other drug and formulation combinations had NNT values above 4, indicating lesser efficacy .
Risks associated with NSAIDs are detailed on the package inserts and Client Information Sheets that accompany all veterinary NSAIDS dispensed to clients. A Client Information Sheet should always be given to the client with each NSAID prescription. Pet owners should read this information carefully. Owners and veterinarians should carefully consider the potential benefits and risks of using an NSAID and other treatment options before deciding to use an NSAID. Use the lowest effective dose for the shortest duration consistent with individual response.
SOURCES: Byron Cryer, MD, spokesman, American Gastroenterological Association; associate professor of medicine, University of Texas Southwestern Medical Center, Dallas. Nieca Goldberg, MD, spokeswoman for the American Heart Association; chief of women's cardiac care, Lennox Hill Hospital, New York; author, Women Are Not Small Men: Lifesaving Strategies For Preventing And Healing Heart Disease In Women . John Klippel, MD, president and CEO, Arthritis Foundation, Atlanta. Scott Zashin, clinical assistant professor, University of Texas Southwestern Medical Center; author of Arthritis Without Pain . American College of Rheumatology web site. Arthritis Foundation web site. American Heart Association web site. American College of Gastroenterology web site. American Gastroenterological Association web site. American Academy of Family Physicians web site. American Academy of Allergy, Asthma, and Immunology web site.