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      Nonsteroidal antiinflammatory drugs (NSAIDs) and physiotherapy management of musculoskeletal conditions: a professional minefield?

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          Abstract

          In Australia, physiotherapy is a primary contact profession when practiced in private ambulatory settings. Primary contact means that physiotherapists take responsibility for diagnosis, decisions on interventions, appropriate ongoing management, and costs related to benefits. For most physiotherapists, the most common clinical presentations relate to symptoms from musculoskeletal conditions. There is considerable research evidence for many “physiotherapy” techniques in the management of musculoskeletal symptoms. As part of these management strategies, some physiotherapists may use nonsteroidal antiinflammatory drugs (NSAIDs) as an adjunct to treatment. Physiotherapists do not have the training or the legislative powers to prescribe NSAIDs. However, they can recommend that patients seek advice about appropriate adjunct NSAIDs from pharmacists and/or medical practitioners. The roles and responsibilities of key health providers in this area appear to be well defined in terms of minimizing medication misadventure and optimizing patient health outcomes. A recent survey of physiotherapist behaviors and practices, however, identified a number of “gray” areas that could confront unwary physiotherapists, or pose dilemmas for those without the support of medical/pharmacist colleagues. These gray areas relate to the adjunct use of topical NSAIDs in physiotherapy management and making recommendations for the use of oral NSAIDs. This paper reports on qualitative data that highlights the dilemmas confronting physiotherapists.

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          Most cited references 12

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          Quantitative systematic review of topically applied non-steroidal anti-inflammatory drugs.

          To review the effectiveness and safety of topical non-steroidal anti-inflammatory drugs in acute and chronic pain conditions. Quantitative systematic review of randomised controlled trials. 86 trials involving 10,160 patients. Measures of treatment success approximating at least 50% reduction in pain, local and systemic adverse effects. Analysis at 1 week for acute and 2 weeks for chronic conditions with relative benefit and number needed to treat. In acute pain conditions (soft tissue trauma, strains, and sprains) placebo controlled trials had a relative benefit of 1.7 (1.5 to 1.9), the number needed to treat was 3.9 (3.4 to 4.4). With analysis by drug (at least three trials), ketoprofen (number needed to treat 2.6), felbinac (3.0), ibuprofen (3.5), and piroxicam (4.2) had significant efficacy. Benzydamine and indomethacin were no different from placebo. In chronic pain conditions (osteoarthritis, tendinitis) placebo controlled trials had a relative benefit of 2.0 (1.5 to 2.7); the number needed to treat was 3.1 (2.7 to 3.8). Small trials (< 40 treated patients) exaggerated effectiveness of topical non-steroidals by 33% in acute conditions but not in chronic conditions. There was no relation between trial quality and treatment effect. In both acute and chronic pain local and systemic adverse events and withdrawal from the study related to the drug had a low incidence and were no different from placebo. Topical non-steroidal anti-inflammatory drugs are effective in relieving pain in acute and chronic conditions.
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            Evidence-Based Management of Acute Musculoskeletal Pain

            (2003)
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              Non-steroidal anti-inflammatory drugs (NSAIDs): physiotherapists' use, knowledge and attitudes.

              This paper reports on a survey regarding physiotherapists' knowledge, use and attitudes to non-steroidal anti-inflammatory drugs (NSAIDs), some of which have recently been re-scheduled to non-prescription dispensing. A written survey instrument was developed and administered to 750 physiotherapists in South Australia, Tasmania and the Australian Capital Territory (50% of the registered physiotherapists). Responses were received from 285 physiotherapists. The survey identified opportunities for patient misuse and misadventures with NSAIDs in conjunction with physiotherapy management. Differences in physiotherapist understanding of the dosage and actions of oral and topic administrations of NSAIDs were highlighted, as were the moral and ethical responsibilities of physiotherapists to patients considering taking NSAIDs. The study identified the need for regular professional updates on quality use of NSAIDs.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                March 2005
                March 2005
                : 1
                : 1
                : 69-76
                Affiliations
                Centre for Allied Health Evidence, University of South Australia SA, Australia
                Author notes
                Correspondence: Saravana Kumar, Centre for Allied Health Evidence, City East Campus, University of South Australia, North Tce, SA, Australia Tel +61 8 8302 2085 Fax +61 8 8302 2766 Email saravana.kumar@ 123456unisa.edu.au
                Article
                1661609
                18360546
                © 2005 Dove Medical Press Limited. All rights reserved
                Categories
                Original Research

                Medicine

                legal and ethical issues, antiinflammatory agents, physiotherapy

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