It is easy to feel overwhelmed by the number of topical creams, balms, gels, patches, and sprays available to treat arthritis pain. Knowing about these products’ active ingredients and relative effectiveness can help people select the ones best suited for them.
Many topical pain relievers are sold over-the-counter, without a prescription, while certain other topical products require a physician’s prescription.
Regardless of how they are applied to skin, most topical pain relievers sold to relieve arthritis pain fall into these categories:
- Counterirritants, which distract from pain
- Salicylates, which have mild anti-inflammatory effects
- Capsaicin products, which may have a role in blocking pain signals
- Lidocaine products, which work as local anesthetics
Over-the-counter topical pain relief products are applied to the skin over the arthritic joint and tend to provide modest, local pain relief.
In the US, the most commonly prescribed topical pain relievers include:
- Non-steroidal anti-inflammatory drugs, or NSAIDs (e.g. Voltaren Gel)
- Concentrated topical lidocaine products, including 5% lidocaine patches (e.g. Lidoderm Patches)
Topical NSAIDs may offer some advantages over their oral medication counterparts, such as reduced gastrointestinal side effects; however, they still carry risks and can interact with some oral medications.
Topical Products Are Absorbed Through the Skin
The active ingredients in topical pain relievers can be absorbed through the skin. Some, like counterirritants sold at drugstores (e.g. Tiger Balm), work at and just below the surface of the skin. Others, like prescription topical NSAIDs, work locally and are also absorbed into the bloodstream.
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Absorption rates depend on many factors, including the type of medication and the individual’s physiology.
- Some topical pain relief products are more effective on painful joints located close to the skin, such as the knuckles and knees, as opposed to deeper joints, such as the lower back and hips.
- Ingredients can enter the bloodstream. Even over-the-counter products, which are considered safe for most people, can produce side effects or interact with other medications.
People may wear latex gloves when applying topical medications to avoid unwanted and excessive medication absorption (unless the joint pain being treated is in the hands).
Using Topical Medications with Other Therapies
Most people use topical pain relief products in combination with other treatments, such as physical therapy exercises or massage. This multipronged approach can maximize pain relief. For example, researchers found that people with hand arthritis got more pain relief from topical creams used in conjunction with hand massage than from hand massage alone. 1 Field T, Diego M, Solien-Wolfe L. Massage therapy plus topical analgesic is more effective than massage alone for hand arthritis pain. J Bodyw Mov Ther. 2014 Jul;18(3):322-5. doi: 10.1016/j.jbmt.2013.12.002. Epub 2013 Dec 10. PubMed PMID: 25042302.
Do Not Use Cold and Hot Compresses with Topicals
Patients with arthritis pain are often advised to use hot and cold compresses, but compresses should not be used at the same time as topical medications. Some topical medications can alter cold and heat perception, and people using compresses can unwittingly burn or damage their skin. In addition, hot and cold compresses can change the rate at which medication is absorbed through the skin.
- 1 Field T, Diego M, Solien-Wolfe L. Massage therapy plus topical analgesic is more effective than massage alone for hand arthritis pain. J Bodyw Mov Ther. 2014 Jul;18(3):322-5. doi: 10.1016/j.jbmt.2013.12.002. Epub 2013 Dec 10. PubMed PMID: 25042302.