Written on the 6 March 2016 by The Compounding Team
When it comes to relieving the pain of achy joints, many people reach for a pain-relieving pill like aspirin or ibuprofen. There may be a better way. When the source of pain is close to the surface, applying a cream, gel, patch, or spray that contains a pain reliever right where it hurts can ease pain and help avoid some of the body-wide side effects of oral pain relievers.
These so-called topical analgesics work best for more superficial joints like the knees, ankles, feet, elbows, and hands. "In those areas, the medication can penetrate closer to the joint," says Dr. Rosalyn Nguyen, a clinical instructor in physical medicine and rehabilitation at Harvard Medical School.
The active ingredient in most topical analgesics is a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen, naproxen, aspirin, or diclofenac. These medications target inflammation, which contributes to pain, swelling, and stiffness.
We do know that oral NSAIDs can quell arthritis pain, but how well do they work when applied to the skin? A scientific review by the Cochrane Collaboration, an international body of health experts, found that some prescription compounded topical NSAIDs can offer the same pain relief as oral medications, but with fewer gastrointestinal concerns.
The advantage of using a topical analgesic is that the medication works locally. Targeting pain more precisely, using a medication applied to the skin, can help skirt the side effects of oral drugs. Thus this can be a boon for people whose stomachs are sensitive to NSAIDs, while other people seek topical NSAIDs because they want to avoid adding another pill to their daily regimen, or may have trouble taking pills.
There are about 20 NSAIDs available. For many people with osteoarthritis, NSAIDs are more effective than acetaminophen because they directly target inflammation, which contributes to pain, swelling, and stiffness.
When taken by mouth, as a pill or liquid, the NSAID is absorbed in the gastrointestinal tract. Then the drug travels in the bloodstream toward the source of the pain. This is important to know. Opposed to this applying a topical NSAID concentrates the medicine near the pain site, but since a small amount still enters the bloodstream, NSAIDs may be off-limits to people at high risk for side effects. This would include people with a history of ulcers or gastrointestinal bleeding. A topical analgesic may also not be the best choice when pain affects an extended area, like the lower back, or affects more than one part of the body.
Using a topical analgesic
Topical analgesics can be applied two to four times a day to control mild to moderate pain. Make sure to wash your hands thoroughly after use so you don't smear the drug into your eyes, nose, mouth, or other mucous membranes.
How well do they work?
A recent scientific review by the Cochrane Collaboration, an international body of health experts, found that some prescription topical NSAIDs offer the same pain relief as oral medications, but with fewer gastrointestinal concerns.
The Cochrane review covered 34 studies involving 7,688 adults who experienced chronic musculoskeletal pain for at least three months. They received several different kinds of topical NSAIDs for their pain. The topical NSAID used was just as effective as oral NSAIDs for arthritis in the knee or hand.
Most patients benefit if:
- your stomach is sensitive to NSAIDs
- the source of pain is near the surface
- the pain comes from a focused area, such as a single joint.
Less benefit if:
- you have active ulcers
- you have a history of gastrointestinal bleeding
- you have severe pain.
Limits on use of topicals
Applied as directed, two to four times a day, topical NSAIDs can control mild to moderate pain. For severe (bone-on-bone) osteoarthritis, topical options probably can't match larger doses of oral medications. Still, even in these cases, a topical drug could help.
"I will recommend it even if the pain is severe in a superficial joint, on the chance it will help to reduce any portion of the pain," says pain specialist Dr. Joanne Borg-Stein, medical director of the Harvard-affiliated Spaulding-Wellesley Rehabilitation Centre in Massachusetts. (Don't combine oral and topical NSAIDs prescriptions or over-the-counter medication without telling your prescribing doctor.)
Some types, such as ibuprofen, ketoprofen, indomethacin, and piroxicam usually require a special order from a compounding pharmacy such as Your Solution Compounding Pharmacy.
Possible side effects
Adverse side effects from topical medications are mild and uncommon. These include redness, itching, and other skin irritation. Dr. Borg-Stein says that when her patients experience skin irritation, the cause is often the material used to make the cream or gel. When that happens, it's possible for a pharmacist to create a preparation with ingredients that are less irritating to your skin. This is one of the skills that Your Solution Compounding Pharmacy specialise in.
Please contact Your Solution Compounding Pharmacy for more information about topical NSAID, or visit us at 1/6 Pine Rivers Office Park, 205 Leitchs Rd. Brendale, QLD.