401 Limited evidence for benefits of non-steroidal anti-inflammatory drugs for tennis elbow

September 30, 2013

PEARLS 401, September 2013, written by Brian R McAvoy.

Clinical Question
How effective are non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain (tennis elbow) in adults?

Bottom Line
Although data from five placebo-controlled trials suggested that topical NSAIDs might be beneficial in improving pain (for up to four weeks, NNT* 7), non-normal distribution of data and other methodological issues precluded drawing firm conclusions. Some people reported a mild skin rash. Evidence of the benefits of oral NSAIDs was conflicting, although use of oral NSAIDs resulted in gastrointestinal adverse effects in some people. Some trials demonstrated greater benefit from glucocorticoid injection than has been seen with NSAIDs in the short term, but this was not apparent in all studies and was not apparent by six months in the only study that included longer-term outcomes (only two studies included in this review followed participants for longer than one month).


Most of the 13 trials included in this review were small (ten trials included 40 or fewer participants) and risk of bias was generally high, with only two trials adequately blinding trial participants. Methodological and reporting issues limited the ability to combine data. None of the trials included a measure of quality of life, and less than half included a measure of function. No direct comparisons between oral and topical NSAIDs were available.
*NNT = number needed to treat to benefit one individual.


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 NSAIDs.

Cochrane Systematic Review
Pattanittum P et al. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Reviews, 2013, Issue 5. Art. No.: CD003686.DOI: 10.1002/14651858. CD003686.pub2. This review contains 15 studies involving 759 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.