Topical nonsteroidal anti-inflammatory drugs for chronic musculoskeletal pain in adultsNonsteroidal anti-inflammatory drugs NSAIDs are widely used in the treatment of pain antu-inflammatory with a variety of indications, including arthritic conditions, but their usefulness is often limited by dose-dependent adverse events AEssuch as gastrointestinal disturbances, cardiovascular events, and renal toxicity. The risk of such effects could be reduced by the use of topical formulations, which offer the potential to deliver analgesic concentrations anti-inflam,atory, at the site of boost testosterone naturally bodybuilding, while minimizing systemic concentrations. The topical preparations currently approved in the United States are diclofenac sodium 1. Each of these topical NSAIDs provide topical nonsteroidal anti-inflammatory cream delivery to subcutaneous tissues for the management of pain associated with osteoarthritis or soft-tissue injuries. Furthermore, these formulations are topical nonsteroidal anti-inflammatory cream significantly associated with the systemic AEs associated with oral NSAIDs; the most common AEs associated with topical formulations are local skin reactions, which are usually anti-ijflammatory and self-limiting.
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This is not an advertisement. I do not sell Voltaren or get paid to refer you to a site that does. Funny how things like this slip through the cracks.
Also, other topical treatments salicylates and capsaicin have shown little potential in the past. Is it mellow and easy-going? The medication gets diluted as it penetrates deeper into tissue, and a meaningful amount can only get into joints if the joint is just under the surface of the skin.
A gel almost completely eliminates the risks associated with digesting the stuff. Here are some of the common injuries conditions I think it might be most useful for:. 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. I have some really thorough icing advice on this website. Obviously icing has some advantages. How drug companies mislead doctors and harm patients.
He was surprised, however, and he changed his mind when he read the evidence. On a few occasions, Scott has proven himself to be even harder to impress than I am which is really saying something.
Over the past two decades, evidence has emerged to demonstrate that topical versions of NSAIDs are well absorbed through the skin and reach therapeutic levels in synovial fluid, muscle, and fascia. One major concern about the use of products like Voltaren is that several conditions that seem to involve inflammation actually do not.
You are probably surprised to hear that tendinitis involves little or no inflammation. You can read all about it in my RSI article:. These drugs can and do cause complications at any dose, and are linked to heart attacks and strokes and ulcerations of the GI tract. Spreading a medication on your skin is not the same thing as swallowing it. Because Voltaren Gel is applied to the skin, dramatically less medication reaches the bloodstream — only a tiny fraction of what you would get from oral usage.
At correct dosages for limited time periods, I think Voltaren Gel is probably very safe: The main advantage of topical NSAIDs is the reduced exposure of the rest of the body to the product, which reduces the side effect profile. Given the toxicity of NSAIDs is related in part to the dose, it follows that topical treatments should have a better toxicity profile. Consequently, the cardiovascular risks of topical diclofenac, even in those with a high baseline risk of disease, should be negligible with the topical forms.
I am definitely not saying Voltaren is completely safe or risk free. With all NSAIDs there may be an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. 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.
The types and risks and benefits of common pain-killers are bewildering although they are much afer than opioids. Over-the-counter OTC pain medications are fairly safe and somewhat effective in moderation and work in different ways, so do experiment cautiously.
There are four kinds: They are all probably equally effective for acute injuries Hung , but benefits vary with people and issues chronic pain, headache, arthritis, etc. Acetaminophen is good for both fever and pain, and is one of the safest of all drugs at recommended dosages , but it may not work well for musculoskeletal pain at all? Low back pain and neck pain often involve a substantial amount of muscle pain, 22 and muscle pain is not particularly inflammatory by nature.
Muscle knots trigger points are more like poisoned muscle than injured muscle. That said, why not try it? I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications , or my blog, Writerly. You might run into me on Facebook or Twitter.
March — Science update. Added several citations substantiating what was previously presented only as a rational opinion: Nonsteroidal anti-inflammatory drugs NSAIDs have shown efficacy in patients with osteoarthritis OA pain but are also associated with a dose-dependent risk of gastrointestinal, cardiovascular, hematologic, hepatic, and renal adverse events AEs.
Topical NSAIDs were developed to provide analgesia similar to their oral counterparts with less systemic exposure and fewer serious AEs.
This reflects the fact that the American guidelines were written several years before the first topical NSAID was approved for use in the United States.
Neither salicylates nor capsaicin have shown significant efficacy in the treatment of OA. An old and small but well-designed test of ibuprofen for muscle soreness, showing a modest but definite benefit for pain, but probably not function. In other words, ibuprofen reduced the soreness only, but had no significant effect on other outcomes, like muscle function and inflammatory markers.
Another very small test of ibuprofen, very similar to Hasson in design and results: P a i nScience. It should be widely available now. Summary of over-the-counter pain-killers.