Topical pain relievers

Carol’s arthritis was getting worse, and the stay-at-home directive from the COVID outbreak gave her even fewer options to stay active. Her back, knees, hands, and right shoulder ached, and she was miserable. She was told to stay away from anti-inflammatory medicines like ibuprofen (Motrin-IB®) and naproxen (Aleve®) because she had developed blood clots in her legs and lungs several times. 
Her family doctor asked me for help. She needed something to relieve her joint pain that would be safe for her while continuing on her blood thinner medicines. 
First, we tried Tylenol Arthritis Extended Relief®, taking two tablets 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?” 
Now there is a safe way for Carol to take an anti-inflammatory medicine like ibuprofen and naproxen. These medicines belong to a family of drugs called Non-Steroidal Anti-inflammatory Drugs, or NSAIDs. 
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 with ulcers, kidney, or heart problems could benefit from using an NSAID regularly. Instead, they may rely on dangerous narcotic pain medicines because of the possible side effects caused by NSAIDs. Luckily, NSAIDs are available as topical gel and patches, and one of the most effective ones, diclofenac, is now available without a prescription. 
Applying an NSAID directly to sore muscles or joints as a cream or gel can relieve pain and stiffness. This approach avoids the side effects that NSAIDs can cause, like stomach pain, burning and bleeding, and heart and kidney problems. 
NSAIDs applied to the skin can ease the acute pain of sprains and strains as well as the chronic pain of osteoarthritis. In September 2012, the Cochran Institute published a review of multiple studies called a meta-analysis on this topic, called Topical NSAIDs for Chronic Musculoskeletal Pain in Adults. They collected and evaluated lots of studies done with topical NSAIDs, many of them unpublished work from the files of drug companies. 
Two medicines, diclofenac and ibuprofen, were able to relieve chronic musculoskeletal pain when applied to the skin. Diclofenac was effective whether used over sore joints and muscles or taken as a pill. 
Carol may get more pain relief if she uses an NSAID gel or cream because using diclofenac gel regularly puts MORE medicine into joints than taking an NSAID pill. 
Topical diclofenac is available as several formulations and brand names in the United States. Until now, it was only available with a prescription. 
Diclofenac is now available without a prescription as Voltaren® 1% gel, applied four times daily. Other options containing diclofenac are still accessible only by prescription. These include diclofenac gel 1% (the generic of Voltaren® gel), Pennsaid® 1.5% solution, used 3-4 times daily, Pennsaid® 2% solution in a pump applied twice daily, and Flector® 1.3% as a patch applied twice daily. 
Here are 5 Tips on Using a Topical NSAID for Pain and Stiffness:
1. 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. 
2. Topical NSAIDS are particularly useful if you take a blood thinner.
Switching to a topical NSAID can be particularly helpful if you take a blood thinner to minimize the risk of stomach pain and bleeding that is common with the pill versions. 
3. Don't take 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 diclofenac (Voltaren®) gel without your doctor's supervision.
4. Don’t skip doses.
When you apply diclofenac gel to your joints several times a day, it builds up, but in a good way. 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. 
5. Consider other topical NSAID options.
If ketorolac gel doesn’t help, you can ask your doctor if you could try a different NSAID. Besides ketorolac, other NSAIDs can relieve pain and swelling when used topically. Ibuprofen, ketoprofen, piroxicam, or indomethacin can be made into a topical gel by a pharmacist who makes specialized formulations.
 
Dr. Louise Achey, Doctor of Pharmacy, is a 40-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Check out her NEW website TheMedicationInsider.com for daily tips on how to take your medicine safely. 2020 Louise Achey

 

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