Seven RCTs were included in the meta-analysis (703 patients).
The pooled patient population appeared homogeneous on examination of baseline demographics and disease data. Drop-out rates ranged from 3.4% to 17.2% in the CS group and from 1.6% to 70.4% in the placebo group. No study was evaluated on an intention-to-treat basis.
VAS pain (7 RCTs): overall mean Glass score for pain improvement for CS compared to placebo = 0.9. This represents a proportion of about 65% of patient taking CS whose pain reduction was superior to placebo.
Algofunctional Lequense index (6 RCTs): overall mean Glass score for pooled mean Lequense index for CS compared to placebo = 0.74. This represents a proportion of about 55% of patient taking CS whose pain reduction was superior to placebo.
Homogeneity assessment from graphical display of effect size: Glass scores for algofunctional Lequense index appear to be homogeneous but Glass scores for pain assessment by VAS appear to demonstrate heterogeneity.
Publication bias: estimation of possible effects of publication bias was revealed as a relative error of about 30%.
CS doses: no statistically significant correlation was found between the CS dose and either VAS pain or Lequense index.
Concomitant medication: NSAIDs and/or analgesic therapy could not be evaluated due to substantial differences in reporting. All seven RCTs reported statistically significant reductions in consumption of NSAIDs and/or analgesic compared to baseline in the CS group and much less marked reductions for placebo. No supporting data were presented.
Patient's and/or physician's global assessment (six RCTs): five groups reported statistically significant difference favouring CS in patient's global assessment between CS and placebo and four groups reported statistically difference in physician's global assessment.
Side-effects: reported as the numbers of adverse events in patients who completed the trials. Reported as mild in all studies. Adverse events in CS treated patients primarily affected the gastrointestinal tract including epigastralgia, diarrhea, and constipation. Other side-effects included skin symptoms, eyelid oedema, lower limb oedema, alopecia and extrasystoles.