Efficacy of transdermal anti-inflammatory patches for musculoskeletal pain: a systematic review and meta-analysis

<b>Aim:</b> To determine the efficacy of transdermal anti-inflammatory patches in the treatment of acute and chronic musculoskeletal pain. <b>Methods:</b> A comprehensive search of: Cochrane Central register of controlled trials, EMBASE, MEDLINE, CINAHL and PubMed, for studies using transdermal anti-inflammatory patches vs placebo for management of musculoskeletal pain, e.g. soft tissue injuries or tendonitis (last search January 2024). Cochrane Risk of Bias Tools v1 was used for quality assessment and GRADE determined certainty of evidence. Meta-analysis was performed. <b>Results:</b> Twenty-three randomized placebo-controlled trials (n = 4729) were included. There was low-certainty evidence that transdermal patches provided statistically and clinically significant pain relief on movement at long-term follow-up for chronic musculoskeletal pain (effect size -2-69 (95% CI: -4.14, -1.24) and at short-term follow-up which was non-clinically significant, (-1.24: 95% CI: -1.78, -0.69). <b>Conclusion:</b> Several types of transdermal anti-inflammatory patches may offer short-term and long-term pain relief for acute and chronic musculoskeletal conditions. However, the clinical significance of this effect for the long-term pain relief was based on low-certainty evidence of transdermal anti-inflammatory patches versus placebo; for short-term pain there was an overall non-clinically significant improvement. Performing a meta-analysis for all outcomes was not possible due to insufficiency in the evidence-base. <b>Protocol registration:</b>www.crd.york.ac.uk/prospero identifier is CRD42020185944. <b>Do medication Patches Really Help with Muscle &amp; Joint Pain? A Review of the evidence.</b> <b>What We Did:</b> We wanted to see if patches containing certain medicines that you stick on your skin can help with muscle and joint pain. We wanted to see if they did this in both in the short term and long term. <b>How We Did It:</b> We searched through medical databases to find research that compared these patches to fake treatments (placebos). We wanted to see if they work for muscle and joint pain. We checked the quality of these studies and combined their results when possible. <b>What We Found:</b> We found 23 studies that included a total of 4729 people. We found that these patches might help with long-term muscle and joint pain, but the evidence wasn't very strong. For short-term pain, the patches showed some improvement, but it wasn't enough to be considered important. <b>Conclusion:</b> Medication patches might help reduce muscle and joint pain in both the short and long term. However, the evidence for long-term pain relief isn't very strong, and the short-term benefits are not that large. This systematic review is the first to compare patches with placebo in musculoskeletal conditions. This systematic review assessed if transdermal patches delivering anti-inflammatory drugs are efficacious in relieving pain in acute and chronic musculoskeletal conditions. The results indicate low-certainty evidence that a variety of transdermal patches on several musculoskeletal conditions improved the pain on movement outcome at long term follow-up compared with placebo. There is low-certainty evidence of no benefit of pain on movement reduction in the medium-term of anti-inflammatory patches compared with placebo. A clinician may opt for anti-inflammatory transdermal patches to treat those with chronic musculoskeletal pain due to the reduction of adverse events associated with anti-inflammatory oral medication. This systematic review included a variety of transdermal patches used and of musculoskeletal conditions treated.

目的：评估经皮抗炎贴剂（transdermal anti-inflammatory patches）在治疗急慢性肌肉骨骼疼痛（musculoskeletal pain）中的疗效。
方法：全面检索Cochrane对照试验中心注册库、荷兰医学文摘数据库（EMBASE）、医学文献数据库（MEDLINE）、护理与健康科学全文数据库（CINAHL）及PubMed数据库，收集2024年1月前发表的、对比经皮抗炎贴剂与安慰剂治疗肌肉骨骼疼痛（如软组织损伤或肌腱炎）的研究。采用Cochrane偏倚风险工具v1评估研究质量，通过GRADE证据质量分级系统（Grading of Recommendations Assessment, Development and Evaluation）确定证据确定性，并进行荟萃分析（meta-analysis）。
结果：共纳入23项随机安慰剂对照试验（randomized placebo-controlled trials，n=4729）。低确定性证据显示，慢性肌肉骨骼疼痛患者使用经皮贴剂后，长期随访中活动时疼痛缓解具有统计学及临床显著性（效应量（effect size）-2.69，95%置信区间（95% confidence interval，CI）：-4.14至-1.24）；短期随访中缓解效果无临床显著性（效应量-1.24，95% CI：-1.78至-0.69）。
结论：多种经皮抗炎贴剂可能对急慢性肌肉骨骼疾病提供短期和长期疼痛缓解。然而，其长期缓解效果的临床显著性基于低确定性证据，短期缓解则整体无临床显著性改善。因证据基础不足，无法对所有结局指标进行荟萃分析。
方案注册：Prospero注册号为CRD42020185944，注册网址为www.crd.york.ac.uk/prospero。
药物贴剂真的能缓解肌肉和关节疼痛吗？一项证据综述
我们做了什么：探究含特定药物的皮肤贴剂是否能缓解肌肉和关节疼痛，以及其短期与长期效果。
我们如何做：检索医学数据库中对比此类贴剂与安慰剂（placebo）的研究，评估研究质量并在可能时合并结果。
我们发现：共纳入23项研究（4729人）。贴剂可能缓解长期肌肉关节疼痛，但证据强度较弱；短期疼痛改善不足以被认为具有临床重要性。
结论：药物贴剂可能在短期和长期缓解肌肉关节疼痛，但长期缓解证据强度弱、短期获益不显著。本系统综述（systematic review）是首次在肌肉骨骼疾病中对比贴剂与安慰剂的研究，评估了抗炎药物经皮贴剂对急慢性肌肉骨骼疼痛的疗效。结果显示，低确定性证据表明多种贴剂在长期随访中改善活动时疼痛结局；中期随访中无缓解获益的低确定性证据。因抗炎经皮贴剂相较于口服抗炎药物的不良事件更少，临床医生可选择其治疗慢性肌肉骨骼疼痛患者。本综述纳入了多种贴剂及肌肉骨骼疾病类型。