The Ache: Oral nonsteroidal anti-inflammatory drugs, or NSAIDs, are widely used to reduce pain and swelling from arthritis and sprains and strains, but they can raise the risk for ulcers, heart attacks and stroke.
The Claim: Gels, patches and other topical NSAIDs can be used directly on the painful area, providing relief with very low levels of the medication entering the bloodstream, say companies that sell the products.
The Verdict: Topical anti-inflammatory medications show similar efficacy to oral drugs in clinical trials, and studies show comparatively small amounts of the medication gets into the bloodstream. Some scientists say it is logical that a lower exposure will result in lower risk, but so far a safety benefit hasn’t been proven.
The topical medications, available only by prescription in the U.S., contain an anti-inflammatory drug called diclofenac. Topical medications work the same way as oral drugs, by inhibiting enzymes involved in pain and inflammation. But they go directly through skin and underlying tissue to the problem area, instead of first traveling through the bloodstream, says Jeff Sherman, chief medical officer of Horizon Pharma PLC of Dublin.
Horizon’s Pennsaid 2%, a solution with the consistency of hand sanitizer, used twice a day for arthritis pain, hit the U.S. market last year. Other products include Voltaren Gel, sold by Endo Pharmaceuticals Inc., of Malvern, Pa., a four-times-daily treatment for knee arthritis; and Flector Patch, sold by Pfizer Inc. and applied twice a day for sprains and strains. Insurers generally cover all three products, but prior authorization may be required, physicians say. Topical NSAIDs are popular in Europe and world-wide, sold over-the-counter in many countries.
Based on the data, the topical products “can work as effectively” for pain relief as oral medications, says David Jevsevar, acting chairman of orthopedics at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and chairman of an expert panel that developed the 2012 American Academy of Orthopaedic Surgeons guidelines on knee arthritis, which suggest topicals as an option.