Carol’s arthritis was getting worse. Her back, knees, hands, and right shoulder ached, making her was miserable. She was told to avoid anti-inflammatory medicines like ibuprofen (Motrin-IB®) and naproxen (Aleve®) because of her blood thinner medication.
Her family doctor asked me, “What could I give Carol for joint pain, that would be safe for her and her blood thinner medicines?”
We tried Tylenol Arthritis Extended Relief® first. She started taking two tablets twice daily, once in the morning and at bedtime. Within a week, Carol’s pain level in her back, knees, and shoulders dropped from a 10/10 to a 6/10.
“My knees and back feel much better, but is there anything you can suggest to help the arthritis in my hands?”
I suggested we try an anti-inflammatory medicine like ibuprofen and naproxen, but as a gel applied to her hands instead of pills.
Ketorolac, ibuprofen, and naproxen belong to a family of drugs called Non-Steroidal Anti-inflammatory Drugs or NSAIDs for short. NSAID medicines help to relieve swelling and pain, whether from a sudden injury like a muscle sprain or strain or chronic inflammation such as arthritis.
Many Americans could benefit from using an NSAID medication for pain and inflammation, but, like Carol, cannot take them safely. Now there is an alternative: several NSAID medicines are available as topical gel and patches.
When rubbed into the skin, NSAIDs help ease the acute pain of sprains and strains and the chronic pain of osteoarthritis. Applying an NSAID gel relieves pain and stiffness without the risk of severe side effects like stomach pain, bleeding, heart, and kidney problems.
In September 2012, the Cochran Institute published a review of multiple studies called a meta-analysis on the topic of Topical NSAIDs for Chronic Musculoskeletal Pain in Adults. They collected and evaluated groups of studies using topical NSAIDs, including some that were completed but never published.
Diclofenac and ibuprofen help relieve muscle and joint pain when applied to the skin. Diclofenac is equally effective whether you use it as a topical gel or take it as a pill. It’s now available without a prescription as Voltaren® 1% gel.
Other formulations of diclofenac are accessible only by a doctor’s order. These include Pennsaid® 1.5% solution 3-4 times daily, Pennsaid® 2% solution applied twice daily, and Flector® 1.3% patch applied twice daily.
Here are 5 Tips on Using a Topical NSAID for Pain and Stiffness:
- Small areas work best.
Topical pain medicines work best for treating a specific area that you can easily reach, like Carol’s arthritis in her hands.
- Topical NSAIDs are safe for people taking a blood thinner.
Switching to a topical NSAID can help address chronic pain and inflammation while minimizing the risk of stomach pain and bleeding from taking NSAID pills.
- Avoid taking more than one anti-inflammatory medicine at a time.
Aleve® (naproxen) and Motrin® (ibuprofen) are closely related to diclofenac. You should avoid taking either of these when using a topical NSAID like Voltaren® gel.
- Don’t skip doses.
When you apply diclofenac gel to your joints several times a day, it builds up, improving its ability to control pain and inflammation. You can get a higher concentration of medicine in your joint fluid using it topically than by taking it as a pill. You’ll get better results without risking dangerous NSAID side effects like stomach bleeding and kidney problems.
- Consider other topical NSAIDs.
If ketorolac gel doesn’t help, you can ask your doctor if you could try applying a different NSAID. Pharmacists who specialize in compounding custom medications can make topical formulations for other NSAIDs like ibuprofen, ketoprofen, piroxicam or indomethacin.
