Harvard Health Letter

NSAIDs: topicals vs. pills for pain

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Topicals aren't as popular, but they can be very effective.

Oral nonsteroidal anti-inflammatory drugs (NSAIDs) are a common fix when you're suffering from osteoarthritis of the knees or hands. But applying NSAIDs directly to the skin (topically) can bring weeks of pain relief, and without the risks of oral NSAIDs, according to a new review by the Cochrane Collaboration, an international research organization. "Topical NSAIDs are an excellent choice for a lot of people, especially those who are at high risk of complications from oral medications," says Dr. Eric Berkson, director of the Sports Performance Center at Harvard-affiliated Massachusetts General Hospital.

NSAIDs and risks

NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn) work by blocking enzymes that affect pain and swelling. NSAIDs are considered generally safe for short-term use. With long-term use, they can cause stomach ulcers and bleeding, liver and kidney damage, and increased risk of heart attacks.

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