Frictional Painkiller Can Ease Arthritis Discomfort

ARCHIVED CONTENT: As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of publication or last revision of each article. Nothing on this site, regardless of date, should ever be used as a substitute for direct medical advice from your physician or other qualified clinician.

When it comes to relieving pain from aching joints, many people opt for a pain reliever like aspirin or ibuprofen. There may be a better way. When the source of the pain is close to the surface, applying a cream, gel, patch or spray containing pain relief to where it hurts can ease the pain and help prevent some of the side effects of oral painkillers on the whole body.

As I write in this month Harvard Men’s Health Watch, these so-called topical pain relievers work best for more superficial joints like the knees, ankles, feet, elbows, and hands. “In these areas, the drug can penetrate closer to the joint,” says Dr. Rosalyn Nguyen, clinical instructor in physical medicine and rehabilitation at Harvard Medical School.

The active ingredient in most topical pain relievers is a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen, naproxen, aspirin, or diclofenac. These drugs target inflammation, which contributes to pain, swelling, and stiffness.

We know that oral NSAIDs can ease arthritis pain. Do they work equally well when applied to the skin? A scientific review by the Cochrane Collaborationan international body of health experts, has found that some topical prescription NSAIDs can provide the same pain relief as oral medications with fewer gastrointestinal issues.

The advantage of using a topical pain reliever is that the medication works locally. Targeting pain more precisely with medication applied to the skin can help circumvent the side effects of oral medications. This can be a boon for people whose stomachs are sensitive to NSAIDs. (Keep in mind that a small amount of the drug still enters the bloodstream and ends up in the stomach and elsewhere, so a topical pain reliever is no guarantee against NSAID-related stomach irritation. .)

Other people seek out topical NSAIDs because they want to avoid adding another pill to their daily regimen or because they have trouble taking pills.

Use of a topical pain reliever

Topical pain relievers can be applied two to four times a day to control mild to moderate pain. Be sure to wash your hands thoroughly after use so you don’t get the medicine in your eyes, nose, mouth, or other mucous membranes.

Side effects of topical medications include redness, itching, and other skin irritations. They are usually mild and rare. The cause of skin irritation is often the material used to make the cream or gel, not the NSAID, says Dr. Joanne Borg-Stein, medical director of the Harvard-affiliated Spaulding-Wellesley Rehabilitation Center in Massachusetts. . When this happens, it is possible for a pharmacist to create a preparation with ingredients that are less irritating to the skin.

A topical pain reliever may not be the best choice when the pain affects a large area, such as the lower back, or affects more than one part of the body.

A key warning about the use of topical pain relievers: Do not use them if you are also taking an oral, prescription or over-the-counter NSAID without talking to your doctor. Taking too many NSAIDs can land you in the hospital with stomach bleeding or an ulcer flare-up. In reality, up to 100,000 Americans are hospitalized each year for gastrointestinal problems related to NSAIDs.

Availability and cost may limit the use of topical NSAIDs. In the United States, the only prescription topical NSAID widely available in pharmacies is diclofenac gel. Other types, such as ibuprofen, ketoprofen (Orudis), indomethacin (Indocin), and piroxicam (Feldene) may require special ordering from a compounding pharmacy.