Physicians typically prescribe topical medications to patients who
- Do not get satisfactory pain relief from over-the-counter medications
- Have sensitivities to oral medications
- Have stomach ulcers or other conditions that can cause gastrointestinal bleeding
In the U.S., prescription topical arthritis pain medications currently include:
- Topical NSAIDs
- Certain lidocaine products, such as 5% lidocaine patches
Like all prescription medication, topical pain relief products are potentially toxic. Patches should be kept away from pets and children and folded and disposed of properly after use.
Prescription Topical NSAIDs
Research evidence suggests topical non-steroidal anti-inflammatory drugs (NSAIDs) reduce arthritis pain as well as oral NSAIDs.1,2 In the U.S., topical NSAIDs for arthritis pain are made with an active ingredient called diclofenac.
Two commonly prescribed diclofenac products are:
- Voltaren Gel, which is FDA-approved to treat pain caused by osteoarthritis in the knees, ankles, feet, elbows, wrists, and hands.
- Pennsaid topical solution, which is FDA-approved to treat pain caused by knee osteoarthritis
Neither product is formally approved for use on deeper joints, such as the shoulder, hip, and low back.
Topical diclofenac users should follow manufacturers’ instructions and carefully measure doses according to the joint being treated. Upper extremity joints (e.g. elbows) require smaller amounts than lower extremity joints (e.g. knees).
Other types of topical NSAIDs, with active ingredients such as ibuprofen or ketoprofen, may be available in Europe or special-ordered from compounding pharmacies. These products may become more widely available in the U.S. in upcoming years.
Topical diclofenac medication has absorption locally, at the site of the painful joint, as well as into the bloodstream. This means topical diclofenac products:
- May pose gastrointestinal side effects, though these side effects tend to be less frequent than with oral NSAIDs.5
- Interact with oral medications, such as oral NSAIDs, aspirin, anticoagulants (e.g. warfarin), and methotrexate.
- Are not ideal for people who have three or more painful joints. Applying medication to several joints can result in too much medication being absorbed through the skin. (For these people, oral medications may be more appropriate.)
In addition, topical NSAIDs may pose other potential risks. For example, the FDA warns that Voltaren Gel poses a potential risk to the liver, and advises patients to tell their doctors if they have liver problems before using diclofenac products.6
To decrease the risk of side effects and interactions, patients should tell their health care provider about medications and supplements they are currently taking.
Prescription Topical Lidocaine
Lidocaine is a local anesthetic sometimes used to treat arthritis and other musculoskeletal pain. It is sold in over-the-counter products as well as in prescription products, including ointments, gels and creams as well as adhesive patches that contain lidocaine solution.
Evidence suggests that 5% lidocaine patches help relieve arthritis pain.7 These patches, sold under the brand name Lidoderm Patch, offer some patients deep pain relief. (One limitation of all topical lidocaine products is that lidocaine does not always penetrate deep below the skin, where joint pain originates.)
Potential side effects and drug interactions
Topical lidocaine numbs the skin and should not be used while icing or heating the painful joint.
It is possible for topical lidocaine to enter the bloodstream. If too much lidocaine is absorbed through the skin, a person can experience serious side effects, such as irregular heartbeats, breathing problems, seizures, and coma. People are advised to use this medication as directed and avoid using more than necessary. For example, Lidoderm Patch users are instructed to use three or fewer patches and to spend at least 12 hours per day without any patches.8