Comments concerning the draft policy were solicited from the stakeholders. Ten responses were received (3 from health professionals, 3 from provincial governments, 2 from health professionals' associations, 1 from a pharmaceutical manufacturers association, and 1 from a pharmaceutical consultant). Three of the respondents agreed with the proposed policy as it is. Others, though supportive of the policy, had specific comments which have been incorporated in the revised version. In addition, a number of questions, concerns, and comments were raised and these are addressed as follows:
The use of topical NSAIDs gels or creams to treat pain has been reported to cause a photocontact dermatitis . Most commonly this has occurred with ketoprofen gel with an incidence of -/1000. Often the reaction appears after stopping the application when the skin is next exposed to sunlight. Therefore it is usually reported in summer. The reaction commonly extends beyond the area where the gel had been applied. The reaction can be severe, requiring hospital admission in some cases. Testing has shown this to be a photoallergic contact dermatitis , crossreacting with other NSAIDs including tiaprofenic acid, fenofibrate, oxybenzone and benzophenone. Bufexamac has also been reported to cause contact dermatitis .
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 .