TOIB Study. Are topical or oral ibuprofen equally effective for the treatment of chronic knee pain presenting in primary care: a randomised controlled trial with patient preference study. [ISRCTN79353052]

Cross, Pamela L; Ashby, Deborah; Harding, Geoffrey; Hennessy, Enid; Letley, Louise; Parsons, Suzanne; Spencer, Anne; Underwood, Martin

doi:10.1186/1471-2474-6-55

Cited by 14 publications

(9 citation statements)

References 37 publications

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“…Early recruitment data indicated a 3:1 preference for topical compared with oral treatment in the preference study and a 2:1 preference for joining the preference study, which compromised the original sample size calculations. 10 To ensure recruitment to the randomised trial the last seven practices to join the study recruited only to the randomised trial. Allowing for the unequal group size, we needed 368 participants in the preference study.…”

Section: Sample Sizementioning

confidence: 99%

Advice to use topical or oral ibuprofen for chronic knee pain in older people: randomised controlled trial and patient preference study

Underwood

Ashby

Cross

et al. 2007

BMJ

Self Cite

105

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Section: Sample Sizementioning

confidence: 99%

Advice to use topical or oral ibuprofen for chronic knee pain in older people: randomised controlled trial and patient preference study

Underwood

Ashby

Cross

et al. 2007

BMJ

Self Cite

105

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“…We carried out a randomised controlled trial and a parallel patient preference study to compare advice to, or the decision to, preferentially use topical or oral NSAIDs, primarily ibuprofen, for knee pain. [1][2][3] In both the randomised trial and the preference study outcomes for knee pain were equivalent. In the randomised trial, however, participants in the oral group had more minor adverse effects and possibly more relief from more widespread pain.…”

Section: Introductionmentioning

confidence: 97%

Influences on older people’s decision making regarding choice of topical or oral NSAIDs for knee pain: qualitative study

Carnes

Anwer

Underwood

et al. 2007

BMJ

Self Cite

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Objective To explore the factors that influence older people's decision making regarding use of topical or oral ibuprofen for their knee pain. Design Qualitative interview study nested within a randomised controlled trial and a patient preference study that compared advice to use oral or topical non-steroidal anti-inflammatory drugs (NSAIDs) for knee pain in older people. Setting 11 general practices. Participants 30 people aged ≥50 with knee pain. Results Participants' decision making was influenced by their perceptions of the associated risk of adverse effects, presence of other illness, nature of their pain, advice received, and practicality. Although participants' understanding of how the medications worked was sometimes poor their decision making about the use of NSAIDs seemed logical and appropriate. Participants' model for treatment was to use topical NSAIDs for mild, local, and transient pain and oral NSAIDs for moderate to severe, generalised, and constant pain (in the absence of other more serious illness or risk of adverse effects). Participants showed marked tolerance and normalisation of adverse effects. Conclusion Participants had clear ideas about the appropriate use of oral and topical NSAIDs. Taking such views into account when prescribing may improve adherence, judgment of efficacy, and the doctor-patient relationship. Tolerance and normalisation of adverse effects in these patients indicate that closer monitoring of older people who use NSAIDs might be needed.

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“…examined topical administration of 5% ibuprofen cream for treatment of knee OA in double‐blind, placebo controlled RCTs and concluded that topical ibuprofen's efficacy is clinically and statistically relevant compared with placebo cream. These studies have been confirmed in a series of studies and evaluations by Underwood's group [40–44] . In essence, the conclusions from these large‐scale evaluations in the general practice setting in southern England are that topical ibuprofen for knee OA, especially long term, has advantages over oral ibuprofen in that there are fewer side effects.…”

Section: Clinical Studies Examining the Use Of Ibuprofen In Managemenmentioning

confidence: 82%

“…These studies have been confirmed in a series of studies and evaluations by Underwood's group. [40][41][42][43][44] In essence, the conclusions from these large-scale evaluations in the general practice setting in southern England are that topical ibuprofen for knee OA, especially long term, has advantages over oral ibuprofen in that there are fewer side effects.…”

Section: Efficacy In Knee Osteoarthritismentioning

confidence: 99%

Osteoarthritis of the knee and hip. Part II: therapy with ibuprofen and a review of clinical trials

Adatia

Rainsford

Kean

2012

Journal of Pharmacy and Pharmacology

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Objectives We review the pharmacological properties and clinical evidence pertaining to the efficacy of ibuprofen as a first-line treatment in hip and knee osteoarthritis (OA). In the context of our previous paper's exploration of the aetiology and pathogenesis of OA as a basis for pharmacotherapy, we discuss the pharmacokinetics (PK) and clinical pharmacodynamics (PD) of ibuprofen relevant to OA. Key findings Although widely used, the benefits and risks of ibuprofen, especially compared with other non-steroidal anti-inflammatory drugs (NSAIDs) and placebo, have only recently been evaluated in OA of the hip and knee in randomizedcontrolled clinical trials (RCT). The efficacy and occurrence of adverse reactions from ibuprofen was compared with placebo in a structural review of the literature and systematic review of RCTs in large-scale clinical trials. Ibuprofen has been found to result in approximately 50-60% improvement over placebo in WOMAC scores, including those reflecting inflammatory joint pain in knee and hip OA or other indices of pain, disability and impaired function. Mega-trials performed in comparison with the newer NSAIDs, the coxibs, have shown that ibuprofen has comparable therapeutic benefits and although serious gastrointestinal conditions are sometimes more frequent after short-term treatment, longer-term (several months) therapy in OA reduces the advantages of the coxibs over other NSAIDs including ibuprofen. Cardiovascular risk, though present with coxibs and some NSAIDs in OA, is lower or slightly so with ibuprofen compared with coxibs. Summary Ibuprofen is effective and relatively safe (especially at low over-thecounter doses and in the short term) for mild-to-moderate OA of the knee and hip. The PK properties of ibuprofen in OA (short plasma t 1 /2) confer advantages of this drug for OA, while evidence for clinically relevant PD benefits in joints of patients with OA, though limited, is suggestive of local anti-inflammatory activity.

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TOIB Study. Are topical or oral ibuprofen equally effective for the treatment of chronic knee pain presenting in primary care: a randomised controlled trial with patient preference study. [ISRCTN79353052]

Cited by 14 publications

References 37 publications

Advice to use topical or oral ibuprofen for chronic knee pain in older people: randomised controlled trial and patient preference study

Advice to use topical or oral ibuprofen for chronic knee pain in older people: randomised controlled trial and patient preference study

Influences on older people’s decision making regarding choice of topical or oral NSAIDs for knee pain: qualitative study

Osteoarthritis of the knee and hip. Part II: therapy with ibuprofen and a review of clinical trials

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