The efficacy of non-steroidal anti-inflammatory drugs (NSAIDS) for shoulder complaints. A systematic review

      This paper is only available as a PDF. To read, Please Download here.


      The medical literature was evaluated with respect to the efficacy of NSAIDs for shoulder complaints. Nineteen randomized clinical trials met the selection criteria and were included in this review. Each publication was independently scored by two blinded reviewers, according to a standardized set of 17 methodological criteria. The studies were ranked according to their total methods score (maximum 100 points). The methodological quality of the majority of the studies was rather disappointing; only 5 trials received a methods score exceeding 50 points. Furthermore, methodological criteria were often inadequately described, particularly those regarding the randomization procedure, co-interventions and control of compliance. The three trials with the highest methods scores demonstrated superior short-term efficacy of NSAIDs in comparison with placebo intervention. Fourteen trials comparing two types of NSAIDs showed no conclusive evidence in favour of a particular NSAID with respect to efficacy or tolerability. Future studies should compare the benefit-risk ratios of NSAIDs and analgesics for shoulder complaints in order to establish whether the use of NSAIDs is more favourable than analgesics, despite the higher risk of adverse reactions from NSAIDs.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Clinical Epidemiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bjelle A
        Epidemiology of shoulder problems.
        Baillieres Clin Rheumatol. 1989; 3: 437-451
        • Bergenudd H
        • Lindgärde F
        • Nilsson B
        • Petersson CJ
        Shoulder pain in middle age. A study of prevalence and relation to occupational work load and psychosocial factors.
        Clin Orthop. 1988; 231: 234-238
        • Chakravarty KK
        • Webley M
        Disorders of the shoulder: an often unrecognised cause of disability in elderly people.
        Br Med J. 1990; 300: 848-849
        • Miedema HS
        Reuma-onderzoek Meerdere Echelons (ROME): Basisrapport. Nederlands Instituut voor Praeventieve Gezondheidszorg TNO, Leiden1994
        • Reeves B
        The natural history of the frozen shoulder syndrome.
        Scand J Rheumatol. 1975; 4: 193-196
        • Binder AI
        • Bulgen DY
        • Hazleman BL
        • Roberts S
        Frozen shoulder: A long-term prospective study.
        Ann Rheum Dis. 1984; 43: 361-364
        • Chard MD
        • Satelle LM
        • Hazleman BL
        The long-term outcome of rotator cuff tendinitis—A review study.
        Br J Rheumatol. 1988; 27: 385-389
        • Chandnani V
        • Ho C
        • Gerharter J
        • Neumann C
        • Kursunoglu-Brahme S
        • Sartoris DJ
        • Resnick D
        MR findings in asymptomatic shoulders: A blind analysis using symptomatic shoulders as controls.
        Clin Imaging. 1992; 16: 25-30
        • Stiles RG
        • Otte MT
        Imaging of the shoulder.
        Radiology. 1993; 188: 603-613
        • Todd PA
        • Clissold SP
        Tenoxicam. An update of its pharmacology and therapeutic efficacy in rheumatic diseases.
        Drugs. 1991; 41: 625-646
        • Koes BW
        • Bouter LM
        • Beckerman H
        • Van der Heijden GJMG
        • Knipschild PG
        Physiotherapy exercises and back pain: a blinded review.
        Br Med J. 1991; 302: 1572-1576
        • Koes BW
        • Assendelft WJJ
        • Van der Heijden GJMG
        • Bouter LM
        • Knipschild PG
        Spinal manipulation and mobilization for back and neck pain: a blinded review.
        Br Med J. 1991; 303: 1298-1303
        • Friedman LM
        • Furberg CD
        • Demets DL
        Fundamentals of Clinical Trials. PSG Publishing Company Inc, Littleton MA1985
        • Petri M
        • Dobrow R
        • Neiman R
        • Whiting-O'Keefe Q
        • Seaman WE
        Randomized, double-blind, placebo-controlled study of the treatment of the painful shoulder.
        Arthritis Rheum. 1987; 30: 1040-1045
        • Adebajo AO
        • Nash P
        • Hazleman BL
        A prospective double blind dummy placebo controlled study comparing triamcinolone hexacetonide injection with oral diclofenac 50 mg TDS in patients with rotator cuff tendinitis.
        J Rheumatol. 1990; 17: 1207-1210
        • Mena HR
        • Lomen PL
        • Turner LF
        • Lamborn KR
        • Brinn EL
        Treatment of acute shoulder syndrome with flurbiprofen.
        Am J Med. 1986; 80: 141-144
        • Zuinen C
        Diclofenac/misoprostol vs diclofenac/ placebo in treating acute episodes of tendinitis/bursitis of the shoulder.
        Drugs. 1993; 45: 17-23
        • Berry H
        • Fernandes L
        • Bloom B
        • Clark RJ
        • Hamilton EBD
        Clinical study comparing acupuncture, physiotherapy, injection and oral anti-inflammatory therapy in shoulder-cuff lesions.
        Curr Med Res Opin. 1980; 7: 121-126
        • Menkes CJ
        Périarthrite scapulo-humérale: efficacité, tolérance et bénéfice thérapeutique compare de l'étodolac (600 mg/j) et du piroxicam (40/20 mg/j).
        Rhumatologie. 1990; 42: 195-200
        • Friis J
        • Jarner D
        • Toft B
        • Christensen K
        • Christophersen J
        • Ibfeldt HH
        • Korsgaard J
        • Skinhoj A
        • Andersen F
        Comparison of two ibuprofen formulations in the treatment of shoulder tendonitis.
        Clin Rheumatol. 1992; 11: 105-108
        • Duke O
        • Zecler E
        • Grahame R
        Anti-inflammatory drugs in periarthritis of the shoulder: a double-blind, between-patient study of naproxen versus indomethacin.
        Rheumatol Rehabil. 1981; 20: 54-59
        • Thumb N
        • Kolarz G
        • Scherak O
        • Mayrhofer F
        The efficacy and safety of fentiazac and diclofenac sodium in periarthritis of the shoulder: a multi-centre, double-blind comparison.
        J Int Med Res. 1987; 15: 327-334
        • Ginsberg F
        • Famaey JP
        A double-blind comparison of slow-release and standard tablet formulations of fentiazac in the treatment of patients with tendinitis and bursitis.
        Curr Med Res Opin. 1985; 9: 442-448
        • Famaey JP
        • Ginsberg F
        Treatment of periarthritis of the shoulder: a comparison of ibuprofen and diclofenac.
        J Int Med Res. 1984; 12: 238-243
        • White RH
        • Paull DM
        • Fleming KW
        Rotator cuff tendinitis: Comparison of subacromial injection of a long acting corticosteroid versus oral indomethacin therapy.
        J Rheumatol. 1986; 13: 608-613
        • Huskisson EC
        • Bryans R
        Diclofenac sodium in the treatment of painful stiff shoulder.
        Curr Med Res Opin. 1983; 8: 350-353
        • Wielandts L
        • Dequecker D
        Double-blind trial comparing fentiazac with phenylbutazone in patients with tendinitis.
        Curr Med Res Opin. 1979; 6: 85-89
        • Smith MD
        • Thomas D
        • McCredie M
        • Brooks PM
        Piroxicam versus naproxen in the treatment of the painful shoulder.
        Pharmatherapeutica. 1986; 4: 585-589
        • Yamamoto M
        • Sugano T
        • Kashiwazaki S
        • Kageyama T
        • Mizushima Y
        • Kameyama M
        Double-blind comparison of piroxicam and indomethacin in the treatment of cervico-brachial syndrome and periarthritis scapulohumeralis (stiff shoulder).
        Eur J Rheumatol Inflamm. 1983; 6: 266-273
        • Rhind V
        • Downie WW
        • Bird HA
        • Wright V
        • Engler C
        Naproxen and indomethacin in periarthritis of the shoulder.
        Rheumatol Rehabil. 1982; 21: 51-53
        • Valtonen EJ
        A comparative short-term trial with Voltaren (diclofenac sodium) and naproxen in soft-tissue rheumatism.
        Scand J Rheumatol. 1978; : 69-73
        • Moser U
        • Walburger H
        • Schwarz HA
        • Gobelet CA
        A double-blind randomised multicentre study with tenoxicam, piroxicam and diclofenac sodium retard in the treatment of ambulant patients with osteoarthritis and extra-articular rheumatism.
        Scand J Rheumatol. 1989; : 71-80
        • Pena M
        Etodolac: analgesic effects in musculoskeletal and postoperative pain.
        Rheumatol Int. 1990; 10 (Suppl.): 9-16
        • Weiler JM
        Medical modifiers of sports injury. The use of non-steroidal anti-inflammatory drugs (NSAIDs) in sports soft-tissue injury.
        Clin Sports Med. 1992; 11: 625-644
        • Avouac B
        Adverse effects of long-term treatment with non-steroid anti-inflammatory drugs.
        in: Munderthaler M Van Zwieten PA Farcot JM Treatment of Chronic Pain Possibilities. Harvard Academic Publications, 1990: 47-62
        • Fries JF
        • Williams CA
        • Bloch DA
        The relative toxicity of non-steroidal anti-inflammatory drugs.
        Arthritis Rheum. 1991; 34: 1353-1360
        • Bradley JD
        • Brandt KD
        • Katz BP
        • Kalasinski LA
        • Ryan SI
        Comparison of an anti-inflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee.
        N Engl J Med. 1991; 325: 87-91
        • Afable RF
        • Ettinger WH
        Musculoskeletal disease in the aged. Diagnosis and management.
        Drugs Aging. 1993; 3: 49-59