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Topical NSAIDs emerge as a promising yet underexplored option for managing acute musculoskeletal pain in children, emphasizing the urgent need for stronger pediatric clinical evidence.
Topical non-steroidal anti-inflammatory drugs (NSAIDs) are widely recognized for effective pain relief in adults with musculoskeletal injuries, but their role in pediatric care remains uncertain. The evidence base is scarce, leaving clinicians cautious about their use in younger populations. To bridge this knowledge gap, researchers conducted a comprehensive scoping review aimed at summarizing current evidence and identifying research gaps surrounding the use of topical NSAIDs for acute musculoskeletal pain in children.
The research team systematically screened 6 electronic databases, along with grey literature and ongoing clinical trials. Studies involved children under 18 years who received topical NSAIDs for acute musculoskeletal pain in emergency, urgent care, or outpatient settings. Only 3 studies met the inclusion criteria—2 randomized controlled trials (RCTs) and one non-randomized trial—comprising a total of 467 participants aged 6–18 years.
The interventions encompassed ketoprofen gel, methyl salicylate/menthol patches, and diclofenac epolamine patches, used for conditions such as ankle sprains and soft tissue injuries. Therapy durations ranged from 30 minutes to 14 days. Across the studies, children generally reported meaningful pain reduction and minimal adverse events, indicating that topical NSAIDs were well-tolerated. However, the studies differed widely in design, dosage, and outcome reporting, making comparisons difficult.
Importantly, no trials directly examined topical vs. oral NSAIDs, and few explored long-term safety, functional recovery, or patient satisfaction. These methodological gaps and small sample sizes limited the overall strength and generalizability of current evidence. Topical NSAIDs could be a viable option for managing acute musculoskeletal pain in pediatric patients, offering localized pain control with fewer systemic effects. Yet, the evidence base remains weak, with high risk of bias and significant heterogeneity across studies.
Experts call for well-designed, large-scale RCTs to determine the true efficacy, safety, and patient-centered outcomes of topical NSAIDs in children before formal clinical recommendations can be made.
Canadian Journal of Emergency Medicine
Topical Non-Steroidal Anti-Inflammatory Drug Use For Pediatric Acute Musculoskeletal Pain: A Scoping Review
Domenic F. Alaimo et al.
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