A newer type of NSAID available is known as the COX-2 inhibitor. COX-2 inhibitors provide the anti-inflammatory effects of blocking the COX-2 enzyme, but do not affect the COX-1 enzyme, reducing the risk of stomach or intestinal damage. COX-2 inhibitors are ideal for patients who are considered to be at an elevated risk for developing stomach or intestinal problems; however, COX-2 inhibitors can increase the risk for damage to the heart, and thus, are not ideal for patients with problems with circulation or other types of heart conditions.
Formulations of topical diclofenac, ibuprofen, ketoprofen, piroxicam, and indomethacin demonstrated significantly higher rates of clinical success (more participants with at least 50% pain relief) than matching topical placebo (moderate or high quality data ). Benzydamine did not. Three drug and formulation combinations had NNTs for clinical success below 4. For diclofenac, the Emulgel® formulation had the lowest NNT of (95% CI to ) in two studies using at least 50% pain intensity reduction as the outcome . Diclofenac plasters other than Flector® also had a low NNT of ( to ) based on good or excellent responses in some studies. Ketoprofen gel had an NNT of ( to ), from five studies in the 1980s, some with less well defined outcomes. Ibuprofen gel had an NNT of ( to ) from two studies with outcomes of marked improvement or complete remission. All other drug and formulation combinations had NNT values above 4, indicating lesser efficacy .