a man with arthritic knees, topical pain relievers, arthritis pain

Chronic pain, whether it is severe or moderate, poses a serious dilemma. People need relief from pain, but most medications that they can use for relief have significant downsides. People often take NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen or naproxen for granted, especially since they are available without prescription. Just like their prescription counterparts such as celecoxib (Celebrex) or diclofenac (Voltaren), these medications can cause digestive irritation, cardiovascular complications and kidney problems. Are topical pain relievers safer?

Voltaren Gel and Flector Patches:

Q. I’ve been using Voltaren Gel and Flector patches for three years. (I call them “magic patches.”) Oral NSAIDS cause me major stomach pains and the patches and gel do not.

I use the gel for arthritis pain in my knees, feet and hips. It works well enough so I can continue my demanding exercise schedule.

These meds don’t go through your liver, kidneys and other sensitive internal organs the same way oral meds do. So far, I’m not having any negative reactions.

Topical Pain Relievers for Joint Pain:

A. Both Voltaren Gel and Flector patches are topical forms of the prescription anti-inflammatory medicine, diclofenac. A thorough independent review concluded that topical diclofenac can provide good relief from osteoarthritis pain for some people (Derry et al, Cochrane Database of Systematic Reviews, Apr. 22, 2016).

Serious reactions appear to be uncommon. That may be because, as you suggest, the topical NSAID does not get into the blood stream to the same degree as oral medications.

Topical Pain Relievers Can Cause Trouble:

Some people do experience digestive upset from topical NSAIDs, however. One reader reported:

“I was prescribed Voltaren Gel for treatment of persistent groin pain related to a running injury. While it did offer some relief, it was no better than taking aspirin. However, I had serious gastrointestinal discomfort; gas, heartburn, painful swallowing. These side effects would clear up within a day or two after discontinuing use of the product.”

The FDA warns about both cardiovascular and GI complications from topical NSAIDs. You can learn more about topical NSAIDs and many nondrug approaches for easing joint pain in our expanded Guide to Alternatives for Arthritis.

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  1. Nancy

    Try Martha Peterson’s Essential somatics you tube videos. Not all my pain is bone and joint but tight muscles. This helps lots!

  2. Mike

    LOL – Those who say that Arnica, Bio Freeze, Perform, Icy Hot, or other such salves, creams and gels help your pain, have no idea what pain is.

    Those type of OTC items can help ease minor discomfort.

  3. Lanelle L

    I have found Blue Emu works great for me. It comes in a spray and a cream in a jar. I use both but prefer the spray. I had problems with my instep hurting prior to going to Paris last year and knew we would be doing a lot of walking, so I took a can of the spray with me just in case. My son wore a different pair of shoes one day and his instep starting hurting. I told him to spray Blue Emu on it and that was the end of his pain.

  4. Dixie

    Arnica gel is excellent for aches, pains, bruises. I also found that rubbing it on my feet for restless legs or feet works quickly, then I sleep good. RealTime is excellent,also. Anything with a mixture of menthol, arnica, and herbs is good.

  5. TERRY

    how effective are otc pain patches for knee osteoarthritis?

  6. Carol

    Arnica gel has been helpful to me in relieving joint pain. Arnica Montana (available orally as well) is a homeopathic remedy. If you have not tried Homeopathy, I recommend it heartily, as it is safe and effective, without the usual side effects of traditional medicine.

    Available online or at your natural health food store and many other drug stores.

  7. Nancy

    Over the past year, I have been learning about various oils infused with herbs, and have used them for joint and neck pain. One of the oils is known as Trauma Oil and contains Arnica, Calendula, and St. John’s Wort.

    Another one contains Meadow Sweet and Arnica. I continue to be amazed at how effective they can be. When I make them up, I also add essential oils (at a safe dilution rate).

    I recently gave some trauma oil to a friend who had a painful injury to her foot after falling down some stairs. The next day, she proclaimed that the oil really made a difference.

  8. Nana Judy
    North Carolina

    Any clinical thoughts about the recent studies about “resistant starch” and promoting good gut bacteria?

  9. Crowner

    For knee and ankle pain I use Perform. My PCP suggested Bio Freeze, but I have not found it in local pharmacies. Perform is a product of the same company. For back pain–I have stress fractures in all lumbar vertebrae and some higher up–I use a heat pad or ICY/HOT patches. Usually I get adequate relief with those procedures.
    For a while I took Aleve, when I needed something more. I quit taking it when I realized it was giving me heartburn.

  10. Laura

    I’ve been using Black Seed Oil on my joints. I am very happy with the results.

  11. mike

    Greetings, I think that the traditional delivery systems for topical meds are effective fro delivery and relief from GI complications. However, there are some really neat nanoparticle delivery systems that are not based on cremes or incipients. Perhaps the Graedons will have a guest in the near future that will talk about some of these innovations. I really encourage folks to utilize compounding formualtions as much as possible. Topically administered durgs can ahve the same efficacy of orally dosed meds-w/o the sideffects of GI and other problems Not much is really known about the gut or enteric nervous system and if you can get relief w the least chance of GI side-effects its worth having compounding prescriptions!

  12. Bruce Higginbotham

    I have found Penetrex ointment to be helpful for joint pain, and it has no NSAIDs at all.

  13. Sherrie Driscoll

    Voltaren Gel helps but is very expensive, even the generic is out of my price range even with insurance coverage.

  14. Mary

    I was concerned about using too many and I called my local homeopathic store and they recommended Herbaprofen. It takes a few minutes longer to take effect but it actually works very good.

    • Harriet

      It now has a generic version

  15. Beverly

    I have had chronic pain in my gluteal muscles and my front and back thighs, radiating down to my knees and sometimes to my ankle. Originally it was thought that I fractured my hip (stress fracture). However, no doctor I went to could find a definitive cause. This has been almost 3 years now. I recently have read info on the fluoroquinolone drugs and there damage and now I am thinking that may be what has happened in my case since I had taken them for 3 days a couple of months before my hip, joint, and muscle pain began. Anyway, I hated how the prescription pain relievers made me feel and didn’t want to continue use of NSAID’s (I suffer from tinnitus due to taking Aleeve). So, I have experimented with about every “natural” pain supplement on the market which would help but not long term and not enough.
    Finally, the other day my reflexologist suggested taking the homeopathic Arnica tables from Hylands (there are other brands too). I also bought the Arnica Gel, same brand, to rub on topically. WOW! I cannot explain the difference in how I am feeling. While not 100%, I do feel I have a good quality of life now and am doing very well. My husband shattered his ankle many years ago and has swelling and pain. He has been going to the chiropractor once a month to get Graston therapy and it helped, however, he says the Arnica gel is a miracle for him. Hardly any swelling and that alleviates his pain. Hope it works as well for others!

  16. Dianne

    I have found excellent relief from daily aching pain from my chronic back and knee problems with Nature’s Way Curcumin Tumeric Concentrate. I take the maximum 2 daily and have thrown away my 6hourly Neuromol.
    However, please check with your GP before trying new medications. ?

  17. Sam
    New Zealand

    Osteoarthritis and an overactive immune system = trigger avoidance and Tramadol for me.
    Anything else = failure.

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