Topical pain relief for arthritis

This is a topical topic indeed for an aging population trying to stay active yet leery of the side effects of pain-relieving drugs. As you are well aware, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin are a mixed blessing of benefits and detriments. While relieving the pain of inflamed joints, these drugs also interfere with the lining of the entire GI tract raising risk of gastritis, ulcers, diarrhea, and colitis. In addition, NSAIDs can restrict blood flow to the kidneys and cause loss of kidney function, and acetaminophen (aka Tylenol) is also known to be toxic to the liver.

I have any number of patients who are unable to take NSAIDs for the above reasons. One middle-aged teacher with severe osteoarthritis had a stomach hemorrhage from aspirin taken for her chronic headaches. We keep seeking alternative relief for her--unfortunately, the latest attempt at using Cymbalta (an antidepressant AND a chronic pain reliever) to control her pain caused her blood pressure to soar. Another teacher/patient developed Stage I renal insufficiency from ibuprofen. We have developed a more or less satisfactory pain program for her with low dose, long-acting narcotics.

So the recent FDA approval of Novartis's Voltaren Gel may be the very thing for joints on fire. The topical application of this longtime NSAID produced significant relief for hand and knee pain in clinical trials. Because it is absorbed and works locally, there may be less potential for the kind of systemic side effects noted above. Per rheumatologist Raymond Flores, MD: "The advantage to this preparation [compared with oral painkillers] is that it seems like it's providing comparable relief but with little systemic absorption."