Rub-on pain reliever can ease arthritis discomfort

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When it comes to relieving the pain of achy joints, many people reach for a pain-relieving pill like aspirin or ibuprofen. There may be a better way. When the source of pain is close to the surface, applying a cream, gel, patch, or spray that contains a pain reliever right where it hurts can ease pain and help avoid some of the body-wide side effects of oral pain relievers.

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

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

We know that oral NSAIDs can quell arthritis pain. Do they work as well when applied to the skin? A scientific review by the Cochrane Collaboration, an international body of health experts, found that some prescription topical NSAIDs can offer the same pain relief as oral medications with fewer gastrointestinal concerns.

The advantage of using a topical analgesic is that the medication works locally. Targeting pain more precisely using a medication applied to the skin can help skirt the side effects of oral drugs. This can be a boon for people whose stomachs are sensitive to NSAIDs. (Keep in mind that a small amount of the medicine still enters the bloodstream and ends up in the stomach and elsewhere, so a topical analgesic isn’t a guarantee against NSAID-related stomach irritation.)

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

Using a topical analgesic

Topical analgesics can be applied two to four times a day to control mild to moderate pain. Make sure to wash your hands thoroughly after use so you don’t smear the drug into your eyes, nose, mouth, or other mucous membranes.

Side effects from topical medications include redness, itching, and other skin irritation. They are generally mild—and uncommon. 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 that happens, it’s possible for a pharmacist to create a preparation with ingredients that are less irritating to your skin.

A topical analgesic may not be the best choice when pain affects an extended area, like the lower back, or affects more than one part of the body.

A key warning about using topical analgesics: don’t use them if you are also taking an oral NSAID—either prescription or over-the-counter—without telling your doctor. Taking too much of an NSAID can land you in the hospital with stomach bleeding or an ulcer flare-up. In fact, up to 100,000 Americans are hospitalized every year for NSAID-related gastrointestinal problems.

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 a special order from a compounding pharmacy.