This Topical Nsaid Is Often Underused
If you suffer from arthritis or other types of pain, you’re probably all too familiar with drugs such as aspirin, Aleve, and Naproxen. All belong to a class of drugs called nonsteroidal anti-inflammatory drugs , and all can be purchased without a prescription. But there is another related drug, available by prescription, you might want to talk with your doctor about: diclofenac, available as a gel, patch, or drop that you apply directly to your skin.
Those topical forms are underused, says Consumer Reports medical director, Orly Avitzur, M.D. “They can be an alternative for people who cannot tolerate the potential side effects of oral NSAIDS,” Avitzur adds.
Their main downside: Cost. A months supply can cost up to $300, depending on which topical you choose and how often it is applied.
If you have back pain, a muscle strain, or joint pain due to arthritis and are considering switching to a topical such as diclofenac gel , drops , or patches , heres what you need to know first.
Topical Medications May Provide Immediate Localized Pain Relief
Several ointments, gels, and creams can help relieve nerve pain by altering the blood flow, reducing inflammation, and creating a numbing effect. Common topical medications that may help relieve sciatica include preparations of4:
- Methyl salicylate
Since topical medications act locally, they may provide immediate pain relief. Some preparations may cause skin irritation, so trying out a small amount initially is recommended.
Coverage And Cost Comparison Of Diclofenac Vs Ibuprofen
Most medicare and health insurance plans cover the generic version of diclofenac. The average retail cost of diclofenac can be around $60. This cost can be lowered to $20-30 with a SingleCare coupon card.
For generic ibuprofen, the cost is often covered by most medicare and insurance plans. Without insurance, the average retail cost can range from $3 to almost $7 per bottle. However, with an ibuprofen coupon, the price can be as low as $3.
Recommended Reading: Does It Hurt To Cut Your Wrist
Taking Diclofenac With Other Painkillers
Diclofenac, aspirin, ibuprofen and naproxen all belong to the same group of medicines called non-steroidal anti-inflammatory drugs . Taking diclofenac together with other NSAIDs may increase your chances of getting side effects like a stomach ache.
NSAIDs are also used in medicines you can buy from pharmacies, such as cough and cold remedies.
Harm To Unborn Babies
- Risk factors: Currently pregnant
If topical diclofenac is used during or after the second trimester of pregnancy, it can lower the amniotic fluid . This can occur as soon as 2 days after starting the medication and result in serious kidney problems in your unborn baby. Babies born to mothers who use topical diclofenac starting in the third trimester of pregnancy or later can also develop heart problems. If you’re thinking of getting pregnant or become pregnant, talk to your provider about the risks and benefits of using topical diclofenac.
Read Also: Piano Carpal Tunnel
Diclofenac Tablets Capsules And Suppositories
You’ll usually take diclofenac tablets, capsules or suppositories 2 to 3 times a day.
The usual dose is 75mg to 150mg a day, depending on what your doctor prescribes for you. Follow your doctor’s advice on how many tablets to take, and how many times a day.
If your doctor prescribes diclofenac for your child, they’ll use your child’s weight to work out the right dose for them.
If you have pain all the time, your doctor may recommend slow-release diclofenac tablets or capsules. You’ll usually take these either once a day in the evening, or twice a day. If you’re taking slow-release diclofenac twice a day, leave a gap of 10 to 12 hours between your doses.
How to take tablets and capsules
Swallow diclofenac tablets or capsules with a drink of milk. If you need to take them with water, take them after a meal or snack. Taking them with milk or food means they’ll be less likely to upset or irritate your stomach.
Swallow them whole, do not crush, break or chew them.
How to use suppositories
What if I use too many plasters or patches or too much gel?
If you use too many plasters or patches or too much gel by mistake, it’s unlikely to do you any harm. But if you use too much and get any side effects, tell your doctor straight away.
Other Options For Over
Lidocaine Lidocaine is available as a patch or a gel. The best evidence shows it is useful in treating neuropathic pain, or pain related to nerve damage. It does not have good evidence to support its use for arthritis-related pain. Lidocaine is a local anesthetic that numbs the nerve endings to relieve pain.
Capsaicin- Capsaicin helps relieve both musculoskeletal and neuropathic pain. It can take up to 4 weeks to work. Patients may feel burning upon application, but that usually goes away over time. Capsaicin works by interrupting the pain signal to the brain and reducing the feeling of pain.
All of these topical medications should only be used sparingly on intact skin. You should also avoid heating the area of the application.
If you have any questions about the new over-the-counter Voltaren Arthritis or to receive some advice on other treatments for pain and arthritis, please contact your Sona Pharmacist!
Read Also: How To Slit Your Wrists Properly
Frequently Asked Questions About Topical Diclofenac
What is osteoarthritis?
Arthritis is a condition where there’s pain, swelling, and stiffness at the joints. Osteoarthritis is one of the most common types of arthritis. It’s most often seen in adults age 65 years and older. It develops when the cartilage, the “cushion” between your joints, wears out over time and your bones rub against each other. This not only leads to pain, swelling, and stiffness, but also lowers your flexibility and range of movement. While osteoarthritis can occur at any joint, it’s most common in the hands, hips, and knees. Topical diclofenac gel and solution works well to treat most joint pain in this condition.
How long does it take for topical diclofenac to work for osteoarthritis?
You might start to feel relief from your pain after a few days of using this medication, but it usually takes about a week to feel significant pain relief. You might need to use this medication for at least 4 weeks to experience maximum benefits.
How is topical diclofenac different from topical lidocaine in treating pain?
Can I use topical diclofenac for osteoarthritis in the hip?
No, topical diclofenac isn’t recommended for hip pain. The hip joint is located deep in the body. It’s unlikely for this medication to be absorbed deep enough under the skin to help with joint pain in the hip.
Can I take ibuprofen tablets along with topical diclofenac gel or solution?
Certain People Should Avoid Using Diclofenac Gel
Women who are trying to get pregnant, are pregnant, or are breastfeeding should not use Voltaren, Pennsaid or Solaraze. These medications can delay ovulation, cause fetal heart defect, and harm a nursing infant.
Patients who develop asthma, hives or other allergic reactions when taking aspirin or NSAIDs should not use diclofenac gel.
People with hypersensitivity to diclofenac should not use Voltaren gel.
Don’t Miss: Is Stomach Pain A Sign Of Pregnancy
Effect Of 15% Topical Diclofenac On Clinical Neuropathic Pain
Submitted for publication May 19, 2014. Accepted for publication March 11, 2015.
Shihab U. Ahmed, Yi Zhang, Lucy Chen, Abigail Cohen, Kristin St. Hillary, Trang Vo, Mary Houghton, Jianren Mao Effect of 1.5% Topical Diclofenac on Clinical Neuropathic Pain. Anesthesiology 2015 123:191198 doi:
Reduced Incidence Of Side Effects
Topical NSAIDs, including gels, liquids and patches are as effective as oral NSAIDs, but generally carry fewer risks and side effects .
Oral NSAIDs, such as ibuprofen, naproxen and aspirin, alleviate pain and swelling, but can increase blood pressure and exacerbate heart conditions. In recent years, the FDA has issued stronger warnings about the increased risk of heart attack and stroke due to oral NSAIDs . Additionally, these medications often cause stomach pain.
In contrast, research indicates that topical NSAIDs provide similar pain relief to oral NSAIDs, with less risk .
A 2017 study investigated the use of topical and oral NSAIDs in the treatment of rheumatoid arthritis, and found that topical NSAID use resulted in fewer instances of cardiovascular complications .
Another study compared oral and topical diclofenac solutions, and found that topical treatments resulted in fewer gastrointestinal and heart-related adverse events .â
Recommended Reading: Lidocaine Muscle Pain
Voltaren For Back Pain Too Maybe Surprisingly
Ive emphasized that Voltaren is mainly appropriate for shallow inflammation, but there is some evidence that Voltaren might be able to reach deeper. This is hardly the stuff of medical certainty yet, but researchers Huang et al found that Voltaren treated pain coming from deep inside the spine, right in the centre.8
Surprisingly, Voltaren may even help some kinds of deep back pain.
They concluded that it could be a convenient and safe clinical intervention for a few types of back pain. An anti-inflammatory gel will likely fail with many kinds of back pain, but theres also virtually no down-side to trying. See my low back pain tutorial for extremely detailed information about medications for back pain.
However, it probably does not work well for deeper tissues in most cases.
For instance, theres evidence that it doesnt work at all for the muscle soreness that follows unfamiliar exercise intensity,9 probably because it cant be absorbed far enough into thick muscle tissue but oral NSAIDs do have a modest effect on that kind of pain1011 .
How Can Topical Diclofenac Hurt Your Stomach
Many people assume that if you rub a medication onto your skin it doesnt go very far. Thats why there is little concern about side effects from gels or creams such as topical diclofenac. But the skin is not an impenetrable barrier.
Researchers have known for years that many medications can be absorbed through the skin and into the systemic circulation. They include nitroglycerin for the heart, fentanyl for pain, testosterone and estradiol for hormone replacement therapy, corticosteroids for inflammation and scopolamine for motion sickness.
You May Like: How To Get Rid Of Stomach Pain After Eating Pineapple
Tips To Use Topical Medication To Relieve Sciatica Pain
Sciatica pain originates in your lower spine and travels down your sciatic nerve into your thigh and leg.
- When you use topical medication, apply the cream/gel or lidocaine patch to your rear pelviswhere your sciatic nerve roots are located.
- Treating this area, rather than your thigh or calf where the pain may be more, will help control and numb the pain at its origin and also calm the nearby nerves.
When you experience pain relief after using topical medication, try to perform simple lower back stretches. Stretches and targeted exercises can help prevent sciatica from recurring, by relieving the sciatic nerve compression, strengthening your tissues, and improving the flexibility in your lower back.
Typical Dosing For Topical Diclofenac
Diclofenac 1% gel: Use the plastic dosing card found inside your box to measure out the amount of gel needed. Apply to the affected area of your body 4 times a day. Don’t use more than 32 grams total per day.
- Joints on lower body : Use up to 4 grams of gel for each dose. Don’t use more than 16 grams per day on any single joint.
- Joints on upper body : Use up to 2 grams for each dose. Don’t use more than 8 grams per day on any single joint.
Diclofenac 1.5% topical solution: The typical dose is to apply 40 drops to each affected knee 4 times a day.
Diclofenac 2% topical solution: The typical dose is to apply 2 pumps to each affected knee 2 times a day.
Also Check: Blueberry Stomach Pain
Diclofenac Sodium Topical Solution
Diclofenac sodium solution is specifically indicated to treat pain associated with osteoarthritis of the knee. It is available in two strengths, 1.5% and 2%.12-14
1.5% Solution:Diclofenac 1.5% solution comes packaged in either 60- or 120-mL bottles with a dropper.12,13 Each mL of solution contains 16.05 mg of active ingredient. For pain relief, patients are instructed to apply 40 drops of solution to each painful knee four times daily. It is recommended that 10 drops be applied at one time and then rubbed in to avoid spillage of the medication. The solution should be dispersed to the front, back, and sides of the knee during administration.12,13
2% Solution:Diclofenac 2% solution is available in a 112-g pump bottle that delivers 20 mg of diclofenac per 1 g of solution per actuation.14 Patients are to apply 2 actuations either into the hand and then onto the knee or directly to the knee twice daily. If pain is located in both knees, two pumps are to be used on each knee twice daily. The solution is then to be spread to all areas of the knee . Prior to first use, the pump needs to be primed by depressing it four times fully and discarding the pumped solution.14
Some Skin Side Effects For Some People
I am definitely not saying Voltaren is completely safe or risk free. No drug is. The drug is still being absorbed, but instead of being a gut burner it can be a skin burner. From the Voltaren® Gel website
The most common adverse reactions reported in Voltaren Gel clinical trials were application site reactions in 7% of treated patients. With all NSAIDs there may be an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal.
Sounds bad, doesnt it? But those warnings are primarily there in an abundance of legal and medical caution provoked by the problems with oral NSAIDs. For short-term, moderate topical use, I believe the benefits clearly outweigh the minor risks.
Read Also: Blueberries And Gastritis
How To Use Diclofenac Sodium Topical
Read the Medication Guide and Patient Instructions for Use provided by your pharmacist before you start using diclofenac and each time you get a refill. If you have any questions, ask your doctor or pharmacist.
This medication is for use on the skin only. To measure the right dose, use the dosing card provided with the medication. Place a dosing card on a flat surface so that you can read the print on the card. Squeeze an even line of the medication from the tube onto the dosing card, using the marks on the card to measure the prescribed dose. Gently rub the medication into the entire affected joint, usually 4 times daily or as directed by your doctor. You may use the dosing card to apply the medication. Do not apply the medication on skin that has cuts, infections, or rashes.
If the package instructions direct you to reuse the dosing card, then after each use, hold the card with your fingertips, rinse, and dry. When you are ready to discard the dosing card, fold the card in half with the medication side inside and throw away out of the reach of children and pets. Wash your hands after using the medication unless you are using it to treat the hands. Do not shower, bathe, or wash any treated areas for at least an hour after applying the medication. Wait at least 10 minutes before covering the treated area with gloves or clothing. Do not wrap, bandage, or apply heat to the treated area.
Tell your doctor if your pain persists or worsens.
When To See A Doctor
If you have new, worsening, or severe shoulder pain, you should seek medical attention.
Some signs that you should be seen by a doctor include:
- Inability to carry objects or use your arm
- An injury that causes joint deformity
- Shoulder pain that occurs at night or while resting
- Shoulder pain that persists beyond a few days
- Inability to raise your arm
- Swelling or significant bruising around your joint or arm
- Signs of an infection, including fever, skin redness and warmth
- Any other unusual symptoms associated with your shoulder painlike abdominal pain or trouble breathing
Dont Miss: Cutting Your Wrist To Die
Recommended Reading: Can Antibiotics Cause Joint Pain
Muscle Relaxants May Reduce Back Pain And Stiffness In Acute Sciatica
Muscle relaxants, such as cyclobenzaprine, relax tight, tense muscles, and reduce spasms. Muscle spasms may develop as a result of the underlying medical condition that causes sciatica, such as a disc problem or inflammation of the lumbar and/or pelvic muscles. These drugs may help relieve back stiffness that results from muscle spasms and may be more beneficial in treating acute sciatica.
Due to their potential side effects and the risk of abuse and dependency, these drugs are used with caution and may not be suitable for people with liver, kidney, and/or heart problems.
Watch Out For Skin Reactions
With topical NSAIDs, the most common side effect is skin irritation, such as dryness and itching, at the application site. That’s just one reason it’s important to follow the label directions carefully and not overuse the products.
To minimize your risks for a skin reaction, Cowling recommends doing a skin test before starting any topical pain reliever and washing your hands immediately after applying. Also dont use topicals on any areas of the body where you have an open wound or broken skin, even a scratch. If you develop severe itching, redness, swelling or any other signs of a worsening skin reaction, contact your doctor.
Finally, if you find that the topical you’re using doesn’t relieve your pain, don’t simply use moretell your doctor. “Don’t make the mistake of thinking topical NSAIDs aren’t absorbed by your body,” says Cowling. “They are, and can cause toxicity.”
Editor’s Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin .
Don’t Miss: Does Lidocaine Work For Nerve Pain