Whats New In This Article
Ten updates have been logged for this article since publication . All PainScience.com updates are logged to show a long term commitment to quality, accuracy, and currency. moreWhens the last time you read a blog post and found a list of many changes made to that page since publication? Like good footnotes, this sets PainScience.com apart from other health websites and blogs. Although footnotes are more useful, the update logs are important. They are fine print, but more meaningful than most of the comments that most Internet pages waste pixels on. I log any change to articles that might be of interest to a keen reader. Complete update logging of all noteworthy improvements to all articles started in 2016. Prior to that, I only logged major updates for the most popular and controversial articles.See the Whats New? page for updates to all recent site updates.
2021 Major additions, more than a thousand words on other topical pain-killers: from literal snake oil to the perfectly cromulent salicylates.
2020 Edited for readability. Added some images.
2020 Widespread minor improvements, collectively substantial. Most notably added information on mechanism of action, some more safety information, more about brands and availability.
2019 Added small new section: Remember, exercise is also an anti-inflammatory medication.
2018 Added a brief anecdote about a personal success.
2018 Added a small section about the safety of long-term regular use.
Study Design And Treatments
This was a prospective, randomized, double-blind, parallel-group, phase 3 study conducted in two countries.
To obtain a minimum total of 700 evaluable patients, 746 patients received one of the following four topical gels, of which 2 g was applied twice daily, with patients allowing for 12±4 h between applications: diclofenac+capsaicin gel: 2% diclofenac and 0.075% capsaicin, diclofenac gel , capsaicin gel and placebo gel.
Patients were randomized to the treatment groups diclofenac+capsaicin, diclofenac, capsaicin, and placebo in a 3:3:3:1 ratio in order to achieve 700 patients eligible for the assessment of the primary endpoint. Randomization was stratified according to application site and country. Patients were blinded to their treatment and all participants were instructed to wear disposable gloves when applying the trial medication.
The interval between the two daily applications of the trial medication was approximately 12 h, which could be shortened or extended by 4 h as long as no more and no less than two applications were administered on each treatment day. Treatments were always to be applied by the patient .
If required, rescue medication was provided by the sponsor using locally sourced, commercially available products.
This Topical Nsaid Is Often Underused
If you suffer from arthritis or other types of pain, you’re probably all too familiar with drugs such as aspirin, Aleve, and Naproxen. All belong to a class of drugs called nonsteroidal anti-inflammatory drugs , and all can be purchased without a prescription. But there is another related drug, available by prescription, you might want to talk with your doctor about: diclofenac, available as a gel, patch, or drop that you apply directly to your skin.
Those topical forms are underused, says Consumer Reports medical director, Orly Avitzur, M.D. “They can be an alternative for people who cannot tolerate the potential side effects of oral NSAIDS,” Avitzur adds.
Their main downside: Cost. A months supply can cost up to $300, depending on which topical you choose and how often it is applied.
If you have back pain, a muscle strain, or joint pain due to arthritis and are considering switching to a topical such as diclofenac gel , drops , or patches , heres what you need to know first.
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How Knee Pain Can Affect You
Knee pain is more common as you get older, due to years of wear and tear, if you are overweight , or if you play sports. Because your knees are vital to movement, knee pain can stop you from playing sports and make it difficult to carry out simple activities, such as walking and climbing stairs.
*Knee : Images, Function, Ligaments, Muscles. 2016. Knee : Images, Function, Ligaments, Muscles. Available at: http://www.webmd.com/pain-management/knee-pain/picture-of-the-knee. . **GSK Global Pain Index Research 2014 full report p. 47
Chill It Diclofenac Gel For Lower Back Pain
Ice is best in the initial 24 to 48 hours after an injury due to the fact that it decreases swelling. Despite the fact that the heat feels excellent because it assists conceal the pain and also it does aid unwind the muscle mass, the warm really irritates the inflammatory processes. After 2 days, you can change to heat if you prefer. Whether you use warmth or ice take it off after about 20 mins to offer your skin a remainder. If pain persists, talk with a doctor.
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How Is Voltaren Different From Aleve
Voltaren works similarly to oral NSAIDs like naproxen by temporarily blocking the production of pain-signaling chemicals called prostaglandins. However, when taking a pill, the medication is distributed to the site of pain through the bloodstream. Voltaren works by penetrating deep through your skin to deliver medicine at the site of arthritis pain.
Voltaren is an alternative to oral analgesics such as Aleve. It targets pain directly at the source to deliver nonsteroidal anti-inflammatory medicine for powerful arthritis pain relief. Its the first full prescription strength nonsteroidal anti-inflammatory gel now available over the counter. And, Voltaren is FDA approved to be used 2x longer than Aleve*
*21 days vs 10 days for Aleve before consulting a doctor.
What Causes Lower Back Pain
This can vary. More often than not, you pull your back from something like lifting furniture or twisting awkwardly the pain isnt from any underlying disease, but risk factors like obesity and physical inactivity also play a key role. The medical term for this is non-specific back pain.² If you injure your back in this way, the soft tissues become inflamed. This inflammation causes pain, and you might get muscle spasms. This explains why anti-inflammatory medicines such as diclofenac, the active ingredient in Voltaren, can be effective at reducing back pain. See the article All about back pain for more details on pain relief for back pain.
Less often, back pain is caused by something specific, such as a problem with a vertebrae or a problem with a nerve around your spine.²
Some things can increase your risk of getting lower back pain. These include:²
- Obesity.² The extra weight can put a strain on your back.
- A sedentary lifestyle where you dont do any or much physical activity.² This can make your abdominal muscles weak, and your spine less stable.
- Your job if it involves heavy lifting, for example. Stress can also cause muscle tension.²,
- Uncomfortable shoes. Its possible that your shoes might change the affect the way you stand and walk and contribute to back pain.¹
*GSK Global Pain Index Report 2018. p.39
Read Also: Ibuprofen For Back Pain Dosage
Diclofenac Tablets Capsules And Suppositories
You’ll usually take diclofenac tablets, capsules or suppositories 2 to 3 times a day.
The usual dose is 75mg to 150mg a day, depending on what your doctor prescribes for you. Follow your doctor’s advice on how many tablets to take, and how many times a day.
If your doctor prescribes diclofenac for your child, they’ll use your child’s weight to work out the right dose for them.
If you have pain all the time, your doctor may recommend slow-release diclofenac tablets or capsules. You’ll usually take these either once a day in the evening, or twice a day. If you’re taking slow-release diclofenac twice a day, leave a gap of 10 to 12 hours between your doses.
How to take tablets and capsules
Swallow diclofenac tablets or capsules with a drink of milk. If you need to take them with water, take them after a meal or snack. Taking them with milk or food means they’ll be less likely to upset or irritate your stomach.
Swallow them whole, do not crush, break or chew them.
How to use suppositories
What if I use too many plasters or patches or too much gel?
If you use too many plasters or patches or too much gel by mistake, it’s unlikely to do you any harm. But if you use too much and get any side effects, tell your doctor straight away.
What Is Voltaren Arthritis Pain Gel
Voltaren Arthritis Pain gel contains diclofenac, a nonsteroidal anti-inflammatory drug . Diclofenac works by reducing substances in the body that cause pain and inflammation.
Voltaren Arthritis Pain gel is used to treat joint pain caused by osteoarthritis in the hands, wrists, elbows, knees, ankles, or feet.
Voltaren Arthritis Pain gel may not be effective in treating arthritis pain elsewhere in the body.
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To Use Topical Diclofenac 2% Topical Solution Follow These Steps:
Warnings For Other Groups
For pregnant women: Before 30 weeks of pregnancy, this drug is a pregnancy category C drug. After 30 weeks of pregnancy, its a pregnancy category D drug.
A category C drug means that means that studies have shown that the drug can be a risk to the offspring of lab animals. However, not enough studies have been done to show risk in humans.
Category D means two things:
Do not use diclofenac if youre pregnant, unless your doctor advises you to. Be especially sure to avoid using diclofenac at 30 weeks of pregnancy and later.
For women who are breastfeeding: This drug may pass into the breast milk, which means it may pass to a child who is breastfed. This may lead to dangerous effects for the child.
Talk to your doctor regarding whether breastfeeding is a good choice for you.
For seniors: Seniors are at higher risk for stomach problems, bleeding, water retention, and other side effects from diclofenac. Seniors may also have kidneys that arent working at peak levels, so the drug can build up and cause more side effects.
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Feel The Joy Of Movement
An alternative to pills, Voltaren helps you take on your day by targeting pain directly at the source to deliver clinically-proven nonsteroidal anti-inflammatory medicine. Discover powerful arthritis pain relief with a proven safety profile.
Where to Buy Voltaren Gel
Available in stores and online at major retailers nationwide.
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Some Skin Side Effects For Some People
I am definitely not saying Voltaren is completely safe or risk free. No drug is. The drug is still being absorbed, but instead of being a gut burner it can be a skin burner. From the Voltaren® Gel website
The most common adverse reactions reported in Voltaren Gel clinical trials were application site reactions in 7% of treated patients. With all NSAIDs there may be an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal.
Sounds bad, doesnt it? 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.
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What Conditions Do Anti Inflammatory Gels And Creams Help
As discussed, the anti-inflammatory gel has to penetrate the skin before it can reach the affected tissues, so the problem area mustnt lie too far away from the skin surface. Therefore anti-inflammatory gels are more likely to assist the following conditions:
- plantar fasciitis
- tennis and golfers elbow
- ligament strains
How Diclofenac Works
Diclofenac suppresses inflammation, fever, and pain mainly by blocking production of prostaglandins, a signalling molecule involved in a huge array of biological processes which is how all the NSAIDs work, broadly speaking.
What seems to be different about diclofenac is that its better at doing NSAID-ish things than other NSAIDs. For instance, it may inhibit prostaglandin-making in both of the two common ways, whereas all the other NSAIDs are either one or the other. But the biochemistry is dazzlingly complex, and there are several other possible mechanisms for making it more potent .
The drug is active biologically for just an hour or two as traditionally measured, but when absorbed into the synovial fluid of joints, it sticks around for least ten hours, which may account for why it particularly makes a difference for arthritis pain.
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Does It Really Work
Voltaren gel is as good if not better than other OTC topical arthritis pain products, says Jonathan M. Greer, MD, president of Arthritis and Rheumatology Associates of Palm Beach and affiliate clinical professor of biomedical sciences at Florida Atlantic University. There are good clinical studies with this product that demonstrate effectiveness, he says. However, he notes that its a mild agent and that it is not as potent as oral NSAIDs.
Dont Forget That Exercise Is Also An Anti
Note that moderate exercise is almost certainly anti-inflammatory as well.19 Which is cool.
Never just use Voltaren . Ideally, even the safest pain-killer should only be used sparingly, and to make it easier to exercise whatever exercise you can do without excessive discomfort.20 Even if youre really hurting, you may still be able to do easy pain-free range of motion exercises. Just beware of overdoing it while medicated!
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Voltaren For Back Pain Too Maybe Surprisingly
Ive emphasized that Voltaren is mainly appropriate for shallow inflammation, but there is some evidence that Voltaren might be able to reach deeper. This is hardly the stuff of medical certainty yet, but researchers Huang et al found that Voltaren treated pain coming from deep inside the spine, right in the centre.10
Surprisingly, Voltaren may even help some kinds of deep back pain.
They concluded that it could be a convenient and safe clinical intervention for a few types of back pain. An anti-inflammatory gel will likely fail with many kinds of back pain, but theres also virtually no down-side to trying. 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.
For instance, theres evidence that it doesnt work at all for the muscle soreness that follows unfamiliar exercise intensity,11 probably because it cant be absorbed far enough into thick muscle tissue but oral NSAIDs do have a modest effect on that kind of pain1213 .
A Move Away From Oral Painkillers
People with back pain are usually told by their health care practitioners to take analgesic medications to relieve their pain.
Out of date Australian guidelines for managing back pain recommend paracetamol as first choice analgesic, NSAIDs as second, and oral opioids as the third line medicines. Paracetamol is still the most purchased over-the-counter painkiller in Australia, but weve shown it to be ineffective for back pain.
The UK 2017 National Institute for Health and Care Excellence guidelines now no longer recommend paracetamol as a stand-alone intervention for back pain. In the UK, NSAIDs are recommended as the analgesic of first choice for back pain, and opioids as second.
However in research published last week, we show NSAIDs like ibuprofen and diclofenac offer only marginal relief from back pain compared to a placebo . Only one in six patients treated with NSAIDs achieved any significant reduction in pain.
We also found people taking NSAIDs are more than twice as likely to experience vomiting, nausea, stomach ulcers or bleeding compared to those taking placebo.
The study raises the question of whether the benefits of NSAIDs outweigh the risk of side effects offered by these drugs.
These results were obtained by reviewing 35 studies of 6,065 people with various types of spinal pain, including lower back pain, neck pain and sciatica .
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Medication Guide Diclofenac Sodium Gel 3%
What is the most important information I should know about Diclofenac Sodium Gel, 3% and medicines called Nonsteroidal Anti-inflammatory Drugs ?Diclofenac Sodium Gel, 3% is an NSAID medicine that is used on the skin only . Do not use Diclofenac Sodium Gel, 3% in or on the eyes. NSAIDs can cause serious side effects, including: Increased risk of a heart attack or stroke that can lead to death. This risk may happen early in treatment and may increase: º with increasing doses of NSAIDs º with longer use of NSAIDs
Do not take or use NSAIDs right before or after a heart surgery called a coronary artery bypass graft “. Avoid taking NSAIDs after a recent heart attack, unless your healthcare provider tells you to. You may have an increased risk of another heart attack if you take or use NSAIDs after a recent heart attack.
Increased risk of bleeding, ulcers, and tears of the esophagus , stomach and intestines: anytime during use
NSAIDs should only be used: exactly as prescribed at the lowest dose possible for your treatment for the shortest time needed
What is Diclofenac Sodium Gel, 3%?Diclofenac Sodium Gel, 3% is an NSAID that is used on the skin to treat a skin condition called actinic keratosis. Diclofenac Sodium Gel, 3% is not for use in children.
Stop using Diclofenac Sodium Gel, 3% and call your healthcare provider right away if you get any of the following symptoms:
This Medication Guide has been approved by the U.S. Food and Drug Administration.Issued: 05/2021