Nonsteroidal Anti-Inflammatory Drugs Versus Corticosteroid for Treatment of Shoulder Pain: A Systematic Review and Meta-Analysis

• Published in: Archives of physical medicine and rehabilitation Vol. 95; no. 10; pp. 1824 - 1831
• Main Authors: Zheng, Xiao-Qing, MSc, Li, Ke, MSc, Wei, You-Dong, MD, PhD, Tie, Hong-Tao, MSc, Yi, Xiao-Yan, MSc, Huang, Wei, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2014
• Subjects: Adrenal Cortex Hormones - therapeutic use; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Corticosteroids; Humans; Meta-Analysis; NSAIDs; Pain Measurement; Physical Medicine and Rehabilitation; Randomized Controlled Trials as Topic; Range of Motion, Articular; Rehabilitation; Shoulder Joint - physiopathology; Shoulder pain; Shoulder Pain - drug therapy; Shoulder Pain - physiopathology; Meta-Analysis; RCT; Corticosteroids; CI; NSAID; SMD; standardized mean difference; randomized controlled trial; NSAIDs; confidence interval; Rehabilitation; Shoulder pain; nonsteroidal anti-inflammatory drug
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2014.04.024

Abstract Objective To compare the treatment efficacy between corticosteroid injection and nonsteroidal anti-inflammatory drugs (NSAIDs) for patients with shoulder pain. Data Sources PubMed and EMBASE databases were searched from inception to January 2014. Reference lists of the retrieved studies were additionally scrutinized. Study Selection Randomized controlled trials (RCTs) comparing corticosteroid injection with NSAIDs for treatment of shoulder pain were included. The primary outcome was remission, and the secondary outcomes were pain relief and improvement of range of active abduction. Study selection was conducted by 2 researchers independently. Any disagreements were solved by discussion and confirmed by the third reviewer. Data Extraction Two reviewers independently conducted data extraction and the quality assessment. Data regarding patients, intervention, control, and outcomes were extracted from the included trials. Data Synthesis Six high-quality RCTs of 267 patients meeting the inclusion criteria were included. For an outcome of remission, NSAIDs were less effective than corticosteroid in 4 or 6 weeks (relative risk, .64; 95% confidence interval, .45–.92). NSAIDs did not significantly differ with corticosteroid in pain relief and improvement of range of active abduction. Conclusions Current meta-analysis suggests that NSAIDs are less effective than corticosteroid in achieving remission in patients with shoulder pain at 4 or 6 weeks after treatment. Considering the limited number of studies and small size of each trial, the results should be interpreted with caution, and more high-quality RCTs are encouraged.