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Shoulder pain - Evidence
Evidence on analgesia for rotator cuff disorders

  • CKS found no systematic reviews or placebo-controlled or comparative trials of topical nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol, or opioid analgesia for shoulder pain.
  • A review [Speed, 2008] found that evidence on the effects of NSAIDs in shoulder disorders was limited by a lack of standardized approaches and the diverse disorders studied. It found a previous systematic review, one additional randomized controlled trial (RCT), and one subsequent RCT comparing oral NSAIDs with placebo for shoulder pain.
    • The included systematic review (search date: 1998) pooled results from two RCTs (n = 90 people with rotator cuff tendinitis) and found no significant reduction in pain and no significant improvement in abduction between oral NSAIDs (diclofenac or naproxen) and placebo after 4 weeks.
    • The additional RCT (n = 69 people with acute shoulder pain) found that oral flurbiprofen significantly improved pain relief compared with placebo at 14 days.
    • The subsequent RCT (n = 306 people with shoulder tendinitis and/or subacromial bursitis) found celecoxib reduced pain at 7 and 14 days compared with placebo, and naproxen reduced pain at 7 days compared with placebo (but no significant difference in pain was found at 14 days).
    • Reported adverse effects included gastrointestinal symptoms, skin rash, headache, and dizziness, which were reported more commonly in the NSAID groups than the placebo groups.
  • A systematic review of the treatment of impingement syndrome and its effect on functional limitation and return to work [Faber et al, 2006] found limited evidence from a placebo-controlled prospective trial that steroid injections and oral diclofenac have a similar effect on functional limitation.
    • The review concluded that there was a lack of high-quality studies and that functional limitations, sickness leave, and work status are not common outcome measures in trials.

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