Topical NSAIDs

What Are Topical NSAIDs?

Topical NSAIDs are anti-inflammatory pain medications applied directly to the skin over a painful area. They provide localized pain relief with fewer systemic side effects than oral NSAIDs. Common examples include diclofenac gel (Voltaren) and topical ibuprofen.¹

Available Products

Prescription

Diclofenac 1% gel (Voltaren Gel)
Diclofenac 1.5% solution (Pennsaid)
Diclofenac patch (Flector)
Ketoprofen gel

Over-the-Counter

Diclofenac 1% gel (Voltaren Arthritis Pain)
Various topical ibuprofen products

How They Work²

Absorbed through the skin
Concentrate in underlying tissues
Reduce inflammation locally
Lower blood levels than oral NSAIDs

What They Treat

Osteoarthritis (especially knees, hands)
Muscle strains and sprains
Tendinitis
Localized musculoskeletal pain

Effectiveness³

Good evidence for knee/hand osteoarthritis
Similar efficacy to oral NSAIDs for superficial conditions
Less effective for deeper joints (hips, spine)
May take several days for full effect

Advantages Over Oral NSAIDs

Fewer GI side effects
Lower cardiovascular risk
Minimal kidney effects
Can be used alongside other pain medications
Good for localized pain

How to Use

Apply to clean, dry skin
Use the measured dose
Rub in gently
Wash hands after applying
Don't cover with bandages unless directed
Avoid sun exposure on treated areas

Side Effects

Skin irritation at application site
Redness, itching, dryness
Rash (discontinue if severe)
Systemic effects rare but possible

Precautions

Don't apply to broken or irritated skin
Avoid eyes and mucous membranes
Check for NSAID allergies
Use caution if on blood thinners
Discuss with doctor if using multiple NSAIDs

References

Derry S, Conaghan P, Da Silva JA, et al. Topical NSAIDs for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev. 2016;4:CD007400.
Heyneman CA, Lawless-Liday C, Wall GC. Oral versus topical NSAIDs in rheumatic diseases: a comparison. Drugs. 2000;60(3):555-574.
Zeng C, Wei J, Persson MSM, et al. Relative efficacy and safety of topical non-steroidal anti-inflammatory drugs for osteoarthritis: a systematic review and network meta-analysis. Br J Sports Med. 2018;52(10):642-650.