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Meta-Analysis
. 2013 May 31;2013(5):CD003686.
doi: 10.1002/14651858.CD003686.pub2.

Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults

Porjai Pattanittum  1 , Tari Turner, Sally Green, Rachelle Buchbinder
Affiliations
Meta-Analysis

Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults

Porjai Pattanittum et al. Cochrane Database Syst Rev. .

Abstract

Background: Lateral elbow pain, or tennis elbow, is a common condition that causes pain in the elbow and forearm. Although self-limiting, it can be associated with significant disability and often results in work absence. It is often treated with topical and oral non-steroidal anti-inflammatory drugs (NSAIDs). This is an update of a review first published in 2002 (search date October 11, 2012).

Objectives: To assess the benefits and harms of topical and oral NSAIDs for treating people with lateral elbow pain.

Search methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, EMBASE and SciSearch up to October 11, 2012. No language restriction was applied.

Selection criteria: Studies were included if they were randomised or quasi-randomised controlled trials (RCTs or CCTs) that compared topical or oral NSAIDs with placebo or another intervention, or compared two NSAIDs in adults with lateral elbow pain. Outcomes of interest were pain, function, quality of life, pain-free grip strength, overall treatment success, work loss and adverse effects.

Data collection and analysis: Two review authors independently selected the studies for inclusion, extracted the data, and performed a risk of bias assessment.

Main results: Fifteen trials, involving 759 participants and reporting 17 comparisons, were included in the review. Four new trials identified from the updated search were included, along with 11 of 14 trials included in the original review (three trials included in the previous review were found not to meet inclusion criteria). Of eight trials that studied topical NSAIDs (301 participants), five compared topical NSAIDs with placebo, one compared manipulative therapy and topical NSAIDs with manipulative therapy alone, one compared leech therapy with topical NSAIDs and one compared two different topical NSAIDs. Of seven trials that investigated oral NSAIDs (437 participants), two compared oral NSAIDs with placebo, one compared oral NSAIDs and bandaging with bandaging alone, three compared oral NSAIDs with glucocorticoid injection, one compared oral NSAIDs with a vasodilator and two compared two different oral NSAIDs. No trials directly compared topical NSAIDs with oral NSAIDs. Few trials used intention-to-treat analysis, and the sample size of most was small. The median follow-up was 2 weeks (range 1 week to 1 year).Low-quality evidence was obtained from three trials (153 participants) suggesting that topical NSAIDs were significantly more effective than placebo with respect to pain in the short term (mean difference -1.64, 95% confidence interval (CI) -2.42 to -0.86) and number needed to treat to benefit (7 (95% CI 3 to 21) on a 0 to 10 scale). Low-quality evidence was obtained from one trial (85 participants) indicating that significantly more participants report fair, good or excellent effectiveness with topical NSAIDs versus placebo at 28 days (14 days of therapy) (risk ratio (RR) 1.49, 95% CI 1.04 to 2.14). No participants withdrew as the result of adverse events, but some studies reported mild adverse effects such as rash in 2.5% of those exposed to topical NSAIDs compared with 1.3% of those exposed to placebo.Low-quality and conflicting evidence regarding the benefits of oral NSAIDs obtained from two trials could not be pooled. One trial found significantly greater improvement in pain compared with placebo, and the other trial found no between-group differences; neither trial found differences in function. One trial reported a withdrawal due to adverse effects for a participant in the NSAIDs group. Use of oral NSAIDs was associated with increased risk of gastrointestinal side effects compared with placebo in one trial in the review. Another trial reported discontinuation of treatment due to gastrointestinal side effects in four participants taking NSAIDs, and another participant developed an allergic reaction in response to oral NSAIDs.Very scant and conflicting evidence regarding the comparative effects of oral NSAIDs and glucocorticoid injection was obtained. One trial reported a significant improvement in pain with glucocorticoid injection, and another found no between-group differences; treatment success was similar between groups (RR of fair, good or excellent effectiveness 0.74; 95% CI 0.43 to 1.26). Transient pain may occur following injection.

Authors' conclusions: There remains limited evidence from which to draw firm conclusions about the benefits or harms of topical or oral NSAIDs in treating lateral elbow pain. Although data from five placebo-controlled trials suggest that topical NSAIDs may be beneficial in improving pain (for up to 4 weeks), non-normal distribution of data and other methodological issues precluded firm conclusions. Some people may expect a mild transient skin rash. Evidence about the benefits of oral NSAIDs has been conflicting, although oral NSAID use may result in gastrointestinal adverse effects in some people. No direct comparisons between oral and topical NSAIDs were available. Some trials demonstrated greater benefit from glucocorticoid injection than from NSAIDs in the short term, but this was not apparent in all studies and was not apparent by 6 months in the only study that included longer-term outcomes.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Results of screening for studies that met inclusion criteria.
2
2
Risk of bias across all trials: review authors' judgements for each risk of bias item presented as percentages across all included trials.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included trial.
1.1
1.1. Analysis
Comparison 1 Topical NSAIDs versus placebo, Outcome 1 Pain at endpoint of study (10 days to 4 weeks) on 10cm VAS (10=maximum pain).
1.2
1.2. Analysis
Comparison 1 Topical NSAIDs versus placebo, Outcome 2 Treatment success (proportion reporting fair, good or excellent overall effectiveness of treatment) at 28 days (14 days of therapy).
1.3
1.3. Analysis
Comparison 1 Topical NSAIDs versus placebo, Outcome 3 Adverse events.
2.1
2.1. Analysis
Comparison 2 Topical NSAID versus leech therapy, Outcome 1 Overall pain (0 to 300mm VAS).
2.2
2.2. Analysis
Comparison 2 Topical NSAID versus leech therapy, Outcome 2 DASH.
2.3
2.3. Analysis
Comparison 2 Topical NSAID versus leech therapy, Outcome 3 Quality of life‐ physical.
2.4
2.4. Analysis
Comparison 2 Topical NSAID versus leech therapy, Outcome 4 Maximum peak grip strength.
2.5
2.5. Analysis
Comparison 2 Topical NSAID versus leech therapy, Outcome 5 Adverse events‐ local skin reaction.
3.1
3.1. Analysis
Comparison 3 Oral NSAIDs versus placebo, Outcome 1 Improvement in pain (100mm vertical VAS) at endpoint of study (28 days).
3.2
3.2. Analysis
Comparison 3 Oral NSAIDs versus placebo, Outcome 2 Improvement in function (100mm vertical VAS at endpoint of study (28 days).
3.3
3.3. Analysis
Comparison 3 Oral NSAIDs versus placebo, Outcome 3 Improvement in pain‐free maximum grip strength (kg) at endpoint of study (28 days).
3.4
3.4. Analysis
Comparison 3 Oral NSAIDs versus placebo, Outcome 4 Treatment success (complete recovery or improved) at 4 weeks.
4.1
4.1. Analysis
Comparison 4 Oral NSAIDs versus glucocorticoid injection, Outcome 1 Treatment success (complete recovery or improved) at 2 or 4 weeks.
4.2
4.2. Analysis
Comparison 4 Oral NSAIDs versus glucocorticoid injection, Outcome 2 Change in grip strength (kPa).
5.1
5.1. Analysis
Comparison 5 Oral NSAIDs versus vasodilator, Outcome 1 Pain (0 to 10 VAS).
6.1
6.1. Analysis
Comparison 6 Oral Diflusinal versus oral Naproxen, Outcome 1 Treatment success defined as no remaining symptoms or improved at 2 weeks.
6.2
6.2. Analysis
Comparison 6 Oral Diflusinal versus oral Naproxen, Outcome 2 Treatment success defined as excellent, very good or good overall pain relief at 2 weeks.
6.3
6.3. Analysis
Comparison 6 Oral Diflusinal versus oral Naproxen, Outcome 3 Number of participants experiencing any adverse effects.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Adelaar 1987 {published data only}
    1. Adelaar R, Maddy L, Emroch L. Diflunisal versus naproxen in the management of mild to moderate pain associated with epicondylitis. Advances in Therapy 1987;4(6):317‐27.
Bäcker 2011 {published data only}
    1. Bäcker M, Ludtke R, Afra D, Cesur O, Langhorst J, Fink M, et al. Effectiveness of leech therapy in chronic lateral epicondylitis: a randomized controlled trial. Clinical Journal of Pain 2011;27(5):442‐7. - PubMed
Burnham 1998 {published data only}
    1. Burnham R, Gregg R, Healy P, Steadward R. The effectiveness of topical diclofenac for lateral epicondylitis. Clinical Journal of Sports Medicine 1998;8:78‐81. - PubMed
Burton 1988 {published data only}
    1. Burton A. A comparative trial of forearm strap and topical anti‐inflammatory as adjuncts to manual therapy in tennis elbow. Manual Medicine 1988;3:141‐3.
Demirtas 1998 {published data only}
    1. Demirtas RN, Oner C. The treatment of lateral epicondylitis by iontophoresis of sodium salicylate and sodium diclofenac. Clinical Rehabilitation 1998;12:23‐9. - PubMed
Erturk 1997 {published data only}
    1. Erturk H, Celiker R, Sivri A, Cetin A, Cindas A. The efficacy of different treatment regiments that are commonly used in tennis elbow. Journal of Rheumatology and Medical Rehabilitation 1997;8:298‐301.
Hay 1999 {published data only}
    1. Hay E, Paterson S, Lewis M, Hosie G, Croft P. Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care. BMJ 1999;319:964‐8. - PMC - PubMed
Jenoure 1997 {published data only}
    1. Jenoure P, Rostan A, Gremion G, Meier J, Grossen R, Bielinki R, et al. Multi‐centre, double‐blind, controlled clinical study on the efficacy of diclofenac epolamine tissugel plaster in patients with epicondylitis. Medicina Dello Sport 1997;50:285‐92.
Labelle 1997 {published data only}
    1. Labelle H, Guibert R. Efficacy of diclofenac in lateral epicondylitis of the elbow also treated with immobilization. Archives of Family Medicine 1997;6:257‐62. - PubMed
Polat 2011 {published data only}
    1. Polat A, Ekinci O, Terzioglu B, Canbora M, Muftuoglu T, Gorgec M. Treatment of lateral epicondylitis using betahistine dihydrochloride. Journal of Musculoskeletal Pain 2011;19(4):201‐6.
Saartok 1986 {published data only}
    1. Saartok T, Eriksson E. Randomized trial of oral naproxen or local injection of betamethasone in lateral epicondylitis of the humerus. Orthopaedics 1986;2:191‐4. - PubMed
Schapira 1991 {published data only}
    1. Schapira D, Linn S, Scharf Y. A placebo‐controlled evaluation of diclofenac diethylamine salt in the treatment of lateral epicondylitis of the elbow. Current Therapeutic Research 1991;49(2):162‐8.
Spacca 2005 {published and unpublished data}
    1. Spacca G, Cacchio A, Forgacs A, Monteforte P, Rovetta G. Analgesic efficacy of a lecithin‐vehiculated diclofenac epolamine gel in shoulder periarthritis and lateral epicondylitis: a placebo‐controlled, multicenter, randomized, double‐blind clinical trial. Drugs Under Experimental & Clinical Research 2005;31(4):147‐54. - PubMed
Stull 1986 {published data only}
    1. Stull P, Jokl P. Comparison of diflunisal and naproxen in the treatment of tennis elbow. Clinical Therapeutics 1986;9(Suppl C):62‐6. - PubMed
Tsuyama 1979 {published data only}
    1. Tsuyama N, Nichikawa K, Tsujimoto M, Miyanaga Y, Mizushima H, Nakajima A. Clinical evaluation of non‐steroidal anti‐inflammation/analgesics for external use － Indomethacin ointment － in the orthopaedic field. Clinical Evaluation 1979;7:285‐309.

References to studies excluded from this review

Abbott 1980 {published data only}
    1. Abbott C, Bouchier‐Hayes T, Hunt H. A comparison of the efficacy of naproxen sodium and a paracetamol/dextropropoxyphene combination in the treatment of soft‐tissue disorders. British Journal of Sports Medicine 1980;14:213‐8. - PMC - PubMed
Auvinet 1995 {published data only}
    1. Auvinet B, Crielaard J, Manteuffel GE, Müller P, Multicenter Piroxicam FDDF European Study Group . A double‐blind comparison of fast dissolving dosage form and diclofenac enteric‐coated tablets in the treatment of patients with acute musculoskeletal disorders. Current Therapeutic Research 1995;56:1142‐53.
Baskurt 2003 {published data only}
    1. Baskurt F, Ozcan A, Algun C. Comparison of effects of phonophoresis and iontophoresis of naproxen in the treatment of lateral epicondylitis. Clinical Rehabilitation 2003;17(1):96‐100. - PubMed
Bolten 1991 {published data only}
    1. Bolten W. Felbinac gel for treatment of localized extra‐articular rheumatic diseases － a multicenter, placebo controlled, randomized study [Felbinac‐Gel zur Behandlung lokalisierter extraartikularer rheumatischer Beschwerden － eine multizentrische, placebokontrollierte, randomisierte studie]. Zeitschrift für Rheumatologie 1991;50:109‐13. - PubMed
Bono 1983 {published data only}
    1. Bono RF, Finkel S, Goodman H, Hanna C. A multicenter, double‐blind comparison of oxaprozin, phenylbutazone, and placebo therapy in patients with tendinitis and bursitis. Clinical Therapeutics 1983;6(1):79‐85. - PubMed
Boussina 1983 {published data only}
    1. Boussina I, Gunthner W, Marti Masso R. Double‐blind multicenter study comparing meclofenamate sodium with indomethacin and placebo in the treatment of extra‐articular rheumatic disease. Arzneimittel‐Forschung 1983;33(4A):649‐52. - PubMed
Buckwalter 1995 {published data only}
    1. Buckwalter JA. Pharmacological treatment of soft‐tissue injuries. The Journal of Bone and Joint Surgery 1995;77A(12):1902‐14. - PubMed
Burgos 2001 {published data only}
    1. Burgos A, Busquier MP, Reino JG, Ferreiro JL, Navarro F, Valverde J, et al. Double‐blind, double‐dummy comparative study of local action transcutaneous flurbiprofen (flurbiprofen LAT) versus piketoprofen cream in the treatment of extra‐articular rheumatism. Clinical Drug Investigation 2001;21(2):95‐102.
Castro DeTolosa 1994 {published data only}
    1. Castro De Tolosa E, Bueno Pereira P, Barreto Reis J, Hideo Hori A. Comparative evaluation of two non‐steroidal anti‐inflammatory drugs in patients with acute tendinitis or bursitis. Arquivos Brasileiros de Medicina 1994;68:203‐7.
Commandre 1983 {published data only}
    1. Commandre F. Double‐blind comparative study of piroxicam and indomethacin in acute locomotor affections linked with sports activity. European Journal of Rheumatology and Inflammation 1983;6:113‐8. - PubMed
Commandre 1993 {published data only}
    1. Commandre F, Zakarian H, Corriol‐Rohou S. Comparison of the analgesic effects of topical niflumic acid gel versus piroxicam gel in the treatment of musculoskeletal disorders. Current Therapeutic Research, Clinical and Experimental 1993;53:113‐21.
Dreiser 1988 {published data only}
    1. Dreiser RL. Clinical trial of efficacy and tolerability of topical ibuprofen in the treatment of tendinitis. Le Journal International de Medicine 1988;119:70‐3.
Dreiser 1991 {published data only}
    1. Dreiser R, Ditisheim A, Charlot J, Lopez A. A double‐blind, placebo controlled study of niflumic acid gel in the treatment of acute tendinitis. European Journal of Rheumatology and Inflammation 1991;11:38‐45. - PubMed
Fauchald 1978 {published data only}
    1. Fauchald N, Ronning F, Saxegaard E, Sjolyst R. Naproxen and phenylbutazone in acute tendinitis: a multi‐center double‐blind comparison. Tidsskrift for Den Norske Laegeforening 1978;98:1004‐6. - PubMed
Fiszman 1985 {published data only}
    1. Fiszman P, Perpetuo J, Sidi A. Ro 12‐0068 (Tenoxicam) in the treatment of extra‐articular inflammatory processes. European Journal of Rheumatology and Inflammation 1985;8:15‐20. - PubMed
Förster 1997 {published data only}
    1. Förster KK, Schmid K, Reichelt A. Sports‐induced acute epicondylitis of the elbow and conservative therapy [Sportbedingte akute epikondylitis des ellenbogens und ihre konservative therapie]. Sportverletz Sportschaden 1997;11:16‐20. - PubMed
Furberg 1985 {published data only}
    1. Furberg B, Lerner A, Nystrom B, Rosen M, Willig P. Antiphlogistics in acute inflammatory conditions in the soft tissues of the musculo‐skeletal system － a double blind comparison of diclofenac and indomethacin. Current Therapeutic Research, Clinical & Experimental 1985;38(3):523‐7.
Gallacchi 1990 {published data only}
    1. Gallacchi G, Mautone G, Lualdi P. Painful inflammatory conditions: topical treatment with diclofenac hydroxyethylpyrrolidine ((R)Flector gel 1%). Clinical Trials Journal 1990;27(1):58‐64.
Geiger 1995 {published data only}
    1. Geiger L, Elsasser R, Bias P, Haag RF. Placebo‐controlled clinical study with Dolobene (R) gel in the treatment of epicondylitis. Deutsche Zeitschrift fur Sportmedizin 1995;46(4):221‐7.
Ginsberg 1994 {published data only}
    1. Ginsberg F, Famaey J. Double‐blind, randomized cross over study of the percutaneous efficacy and tolerability of a topical indomethacin spray versus placebo in the treatment of tendinitis. Journal of Musculoskeletal Pain 1994;2(1):127‐8. - PubMed
Goldberg 1985 {published data only}
    1. Goldberg D, Rondier J, Oberlin F, Cayla J, Parier J. Preliminary study of the local injection of superoxide dismutase in epicondylitis [Etude preliminarie de l'injection locale de superoxyde dismutase au cours des epicondylites]. Revue du Rhumatisme et des Maladies Osteo‐Articulaires 1985;52(4):291. - PubMed
Grossi 1986 {published data only}
    1. Grossi E, Monza GC, Pollavini S, Bona L. NSAID ionisation in the management of soft‐tissue rheumatism: role played by the drug, electrical stimulation and suggestion. Clinical and Experimental Rheumatology 1986;4(3):265‐7. - PubMed
Gui 1982 {published data only}
    1. Gui L, Pellacci F, Ghirardini G. Use of ibuprofen cream in ambulatory orthopaedic patients: double‐blind comparison with placebo. Clinica Terapeutica 1982;101:363‐9. - PubMed
Halle 1986 {published data only}
    1. Halle J, Franklin RJ, Karalfa L. Comparison of four treatment approaches for lateral epicondylitis of the elbow. Journal Orthopaedic Sports Physical Medicine 1986;8(2):62‐9. - PubMed
Hofman 2000 {published data only}
    1. Hofman J, Nasswetter G, Cayetti LM. Lysine clonixinate gel in soft tissue injuries: controlled randomized prospective double‐blind clinical trial with diclofenac. Presna Medica Argentina 2000;87:513‐20.
Hughes 1969 {published data only}
    1. Hughes GR, Currey HL. Hypospray treatment of tennis elbow. Annals of the Rheumatic Diseases 1969;28(1):58‐62. - PMC - PubMed
Jakobsen 1988 {published data only}
    1. Jakobsen T, Petersen L, Christiansen S, Haarbo J, Munch M, Larsen P, et al. Double‐blind comparative study of tenoxicam, piroxicam, and placebo in acute soft‐tissue injuries. Current Therapeutic Research, Clinical and Experimental 1988;44(4):516‐27.
Jakobsen 1991 {published data only}
    1. Jakobsen T, Petersen L, Christiansen S, Haarbo J, Munch M, Larsen PB, et al. Should athletic injuries be treated with non‐steroidal anti‐rheumatic agents (NSAID)?. Ugeskrift for Laeger 1991;153:2003‐5. - PubMed
Jensen 2001 {published data only}
    1. Jensen B, Bliddal H, Danneskiold‐Samsoe B. Comparison of two different treatments for lateral epicondylitis. Ugeskrift for Laeger 2001;163(10):1427‐31. - PubMed
Karinen 1999 {published data only}
    1. Karinen P, Kemola T, Pienimaki T, Koivukangas P, Vanharanta H. Economic evaluation of two different treatments of the tennis elbow. 15th Annual Meeting of the International Society of Technology Assessment in Health Care. 1999.
Kneer 1994 {published data only}
    1. Kneer W, Kuhnau S, Bias P, Haag RF. Dimethylsulfoxide (DMSO) gel for the treatment of acute tendinopathy. A multicentre placebo‐controlled randomized study. Fortschritte der Medizin 1994;112:142‐6. - PubMed
Kroll 1989 {published data only}
    1. Kroll M, Wiseman R, Guttadauria M. A clinical evaluation of piroxicam gel: an open comparative trial with diclofenac gel in the treatment of acute musculoskeletal disorders. Clinical Therapeutics 1989;11:382‐91. - PubMed
Lecomte 1994 {published data only}
    1. Lecomte J, Buyse H, Taymans J, Monti T. Treatment of tendinitis and bursitis: a comparison of nimesulide and naproxen sodium in a double‐blind parallel trial. European Journal of Rheumatology and Inflammation 1994;14:29‐32. - PubMed
Lopez 1997 {published data only}
    1. Lopez A, Auguste P, Maurandy P, Tamisier S, Wullaert P, Martin C, et al. Efficacy and safety of oral niflumic acid in the treatment of acute tendinitis of the limbs (a multicenter, randomised, double‐blind, placebo‐controlled trial). Les Semaines des Hôpitaux Thérapeutique 1997;73:953‐60.
McGuinness 1969 {published data only}
    1. McGuinness BW, Lloyd‐Jones M, Fowler PD. A double‐blind comparative trial of 'parazolidin' and paracetamol. British Journal of Clinical Practice 1969;23(11):542‐5. - PubMed
Meloni 1995 {published data only}
    1. Meloni P, Demuro G, Cara L, Garau D, Uras G, Suddu L. Evaluation of the effectiveness and tolerability of MED 15 vs piroxicam in patients with acute epicondylitis. Clinica Terapeutica 1995;146(6‐7):453‐6. - PubMed
Menkes 1990 {published data only}
    1. Menkes C, Laoussadi S, Kac‐Ohana, Lasserre O. Controlled trial of injectable diclofenac in mesotherapy for the treatment of tendinitis [Essai controle du diclofenac injectable en mesotherapie dans le traitement des tendinites]. Revue du Rhumatisme et des Maladies Osteo‐Articulaires 1990;57:589‐91. - PubMed
Nilsson 2012 {published data only}
    1. Nilsson P, Baigi A, Sward L, Moller M, Mansson J. Lateral epicondylalgia: a structured programme better than corticosteroids and NSAID. Scandinavian Journal of Occupational Therapy 2012;19(5):404‐10. - PubMed
Percy 1981 {published data only}
    1. Percy EC, Carson JD. The use of DMSO in tennis elbow and rotator cuff tendinitis: a double‐blind study. Medicine and Science in Sports and Exercise 1981;13(4):215‐9. - PubMed
Primbs 1983 {published data only}
    1. Primbs P, Tomasi M. Results of a double‐blind study with Amuno gelo vs. placebo. Fortschritte der Medizin 1983;101:242‐4. - PubMed
Ritchie 1996a {published data only}
    1. Ritchie LD, Johnson N. A willingness to pay analysis: comparison of the patient preference for topical flurbiprofen local action cutaneous patches and piroxicam gel. British Journal of Medical Economics 1996;10:291‐302.
Ritchie 1996b {published data only}
    1. Ritchie LD. A clinical evaluation of flurbiprofen LAT and piroxicam gel: a multicentre study in general practice. Clinical Rheumatology 1996;15(3):243‐7. - PubMed
Rosenthal 1982 {published data only}
    1. Rosenthal M. The application of an extract of human placenta in the treatment of rheumatic affections. International Journal of Tissue Reactions 1982;4(2):147‐51. - PubMed
Rosenthal 1984 {published data only}
    1. Rosenthal M. The efficacy of flurbiprofen versus piroxicam in the treatment of acute soft tissue rheumatism. Current Medical Research and Opinion 1984;9(5):304‐9. - PubMed
Saggini 1997 {published data only}
    1. Saggini R, Zoppi M, Vecchiet F, Gatteschi L, Obletter G, Giamberardino MA. Comparison of electromotive drug administration with ketorolac or placebo in patients with pain from rheumatic disease. Clinical Therapeutics 1997;18(6):1169‐74. - PubMed
Saudan 1977 {published data only}
    1. Saudan Y. Non‐surgical treatment of the acute and chronic epicondylitis (tennis elbow). Therapeutische Umschau 1977;34(2):81‐7. - PubMed
Schorn 1986 {published data only}
    1. Schorn D. Tenoxicam in soft tissue rheumatism. South African Medical Journal 1986;69:301‐3. - PubMed
Seligra 1990 {published data only}
    1. Seligra A, Ingles F. A comparative study of naproxen gel and flufenamic acid gel in the treatment of soft tissue injuries. Current Medical Research and Opinion 1990;12(4):249‐54. - PubMed
Sileghem 1991 {published data only}
    1. Sileghem A, Verstraeten A, Dequeker J. Double‐blind, randomised, parallel‐group study of the efficacy and safety of poglumetacin and naproxen in periarthritis of the shoulder or elbow. Current Therapeutic Research 1991;1:93‐100.
Thorling 1990 {published data only}
    1. Thorling J, Linden B, Berg R, Sandahl A. A double blind comparison of naproxen gel and placebo in treatment of soft tissue injuries. Current Medical Research and Opinion 1990;12(4):242‐8. - PubMed
Turbio 1993 {published data only}
    1. Turbio F, Ishida A, Laredo F. Etodolac versus diclofenac in acute tendinitis and bursitis. Arquivos Brasilieiros de Medicina 1993;67:217‐23.
Vecchini 1984 {published data only}
    1. Vecchini L, Grossi E. Ionisation with diclofenac sodium in rheumatic disorders: a double blind placebo controlled trial. Journal of International Medical Research 1984;12:346‐50. - PubMed
Venerando 1973 {published data only}
    1. Venerando A, Santilli G. Use of 2‐(4‐isobutylphenyl)‐propionic acid (brufen) in the treatment of some diseases of athletes [Sull'impiego dell'acido 2‐(4‐isobutilfenil)‐propionico (Brufen) nel trattamento di alcune atlopatie]. Minerva Medica 1973;64(48):2537‐9. - PubMed
Wiseman 1987 {published data only}
    1. Wiseman R, Sodergren J, Guttadauria M, Ryan A. Treatment of acute musculoskeletal disorders with piroxicam: results of a double‐blind multicenter comparison with naproxen. Current Therapeutic Research, Clinical and Experimental 1987;42:974‐87.

Additional references

Alizadehkhaiyat 2007
    1. Alizadehkhaiyat O, Fisher AC, Kemp GJ, Frostick SP. Pain, functional disability, and psychologic status in tennis elbow. Clinical Journal of Pain 2007;23:482‐9. - PubMed
Allander 1974
    1. Allander E. Prevalence, incidence and remission rates of some common rheumatic diseases and syndromes. Scandinavian Journal of Rheumatology 1974;3:145‐53. - PubMed
Biskupiak 2006
    1. Biskupiak JE, Brixner DI, Howard K, Oderda GM. Gastrointestinal complications of over‐the‐counter nonsteroidal antiinflammatory drugs. Journal of Pain & Palliative Care Pharmacotherapy 2006;20(3):7‐14. - PubMed
Bisset 2005
    1. Bisset L, Paungmali A, Vicenzino B, Beller E. A systematic review and meta‐analysis of clinical trials on physical interventions for lateral epicondylalgia. British Journal of Sports Medicine 2005;39(7):411‐22. - PMC - PubMed
Boisaubert 2004
    1. Boisaubert B, Brousse C, Zaoui A, Montigny JP. Nonsurgical treatment of tennis elbow [Analyse de la littérature: Les traitements non chirurgicaux de la tendinopathie des épicondyliens]. Annales de Readaptation et de Medecine Physique 2004;47(6):346‐55. - PubMed
Bot 2005
    1. Bot SD, Waal JM, Terwee CB, Windt DA, Schellevis FG, Bouter LM, et al. Incidence and prevalence of complaints of the neck and upper extremity in general practice. Annals of the Rheumatic Diseases 2005;64(1):118‐23. - PMC - PubMed
Cates 2008 [Computer program]
    1. Cates C. Visual Rx. Version 3. Dr Christopher Cates, 2008.
Clarke 2010
    1. Clarke AW, Ahmad M, Curtis M, Connell DA. Lateral elbow tendinopathy: correlation of ultrasound findings with pain and functional disability. American Journal of Sports Medicine 2010;38:1209‐14. - PubMed
Deeks 2009
    1. Deeks JJ, Higgins JPT, Altman DG, on behalf of the Cochrane Statistical Methods Group (Editors). Chapter 9: Analysing data and undertaking meta‐analyses. Higgins JFT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration, 2009. Available from www.cochrane‐handbook.org.
Dworkin 2008
    1. Dworkin RH, Turk DC, Wyrwich KW, Beaton D, CleelandCS, Farrar JT, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. The Journal of Pain 2008;9(2):105–21. - PubMed
Garcia 2001
    1. Garcia Rodriguez LA, Hernandez‐Diaz S. Relative risk of upper gastrointestinal complications among users of acetaminophen and nonsteroidal anti‐inflammatory drugs. Epidemiology 2001;12(5):570‐6. - PubMed
Green 2002
    1. Green S, Buchbinder R, Barnsley L, Hall S, White M, Smidt N, Assendelft W. Acupuncture for lateral elbow pain. Cochrane Database of Systematic Reviews 2002, Issue 1. [DOI: 10.1002/14651858.CD003527] - DOI - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Altman DG, Sterne JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hume 2006
    1. Hume PA, Reid D, Edwards T. Epicondylar injury in sport: epidemiology, type, mechanisms, assessment, management and prevention. Sports Medicine 2006;36:151‐70. - PubMed
Kearney 2006
    1. Kearney P, Baigent C, Godwin J, Halls H, Emberson J, Patrono C. Do selective cyclo‐oxygenase‐2 inhibitors and traditional non‐steroidal anti‐inflammatory drugs increase the risk of atherothrombosis? Meta‐analysis of randomised trials. BMJ 2006;332:1302‐8. - PMC - PubMed
Mallen 2009
    1. Mallen CD, Chesterton LS, Hay EM. Tennis elbow. BMJ 2009;339:b3180. - PubMed
Moore 2010a
    1. Moore RA, Eccleston C, Derry S, Wiffen P, Bell RF, Straube S, et al. "Evidence" in chronic pain‐establishing best practice in the reporting of systematic reviews. Pain 2010;150(3):386‐9. - PubMed
Nirschl 1979
    1. Nirschl RP, Pettrone FA. Tennis elbow: the surgical treatment of lateral epicondylitis. Journal of Bone and Joint Surgery 1979;61(6A):832‐9. - PubMed
Ranney 1995
    1. Ranney D, Wells R, Moore A. Upper limb musculoskeletal disorders in highly repetitive industries: precise anatomical physical findings. Ergonomics 1995;38:1408‐23. - PubMed
RevMan2011 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). http://www.cc‐ims.net/revman/download. Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Rompe 2007
    1. Rompe JD, Overend TJ, MacDermid JC. Validation of the Patient‐rated Tennis Elbow Evaluation Questionnaire. Journal Hand Therapy 2007;20:3‐10. - PubMed
Roquelaure 2006
    1. Roquelaure Y, Ha C, Leclerc A, Touranchet A, Sauteron M, Melchior M, et al. Epidemiologic surveillance of upper‐extremity musculoskeletal disorders in the working population. Arthritis and Rheumatism 2006;55(5):765‐78. - PubMed
Schünemann 2011a
    1. Schünemann HJ, Oxman AD, Higgins JPT, Vist GE, Glasziou P, Guyatt GH. Chapter 11: Presenting results and 'Summary of findings' tables. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org. [Available from www.cochrane‐handbook.org]
Schünemann 2011b
    1. Schünemann HJ, Oxman AD, Vist GE, Higgins JPT, Deeks JJ, Glasziou P, et al. Chapter 12: Interpreting results and drawing conclusions. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org. [Available from www.cochrane‐handbook.org]
Shiri 2006
    1. Shiri R, Viikari‐Juntura E, Varonen H, Heliovaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. American Journal of Epidemiology 2006;164(11):1065‐74. - PubMed
Walker‐Bone 2004
    1. Walker‐Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis and Rheumatism 2004;51(4):642‐51. - PubMed

References to other published versions of this review

Green 2002a
    1. Green S, Buchbinder R, Barnsley L, Hall S, White M, Smidt N, Assendelft WJJ. Non‐steroidal anti‐inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database of Systematic Reviews 2002, Issue 4. [DOI: 10.1002/14651858.CD003686] - DOI - PubMed

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