What Creams Are NSAIDs? A Guide to Topical Anti-Inflammatory Relief

According to a Cochrane review, topical nonsteroidal anti-inflammatory drugs (NSAIDs) can provide effective pain relief for localized musculoskeletal conditions, often with fewer systemic side effects than their oral counterparts. If you're wondering What creams are NSAIDs?, this guide will explain the science and list the most common products available to help you find relief.

Quick Summary

This guide details what topical nonsteroidal anti-inflammatory drugs are and how they work. Learn about common products containing diclofenac, their primary uses, and how they differ from other pain relief options.

Key Points

• Localized Action: Topical NSAID creams deliver medication directly to the site of pain and inflammation with minimal systemic absorption.

• Diclofenac is Key: The most common topical NSAID is diclofenac, found in brands like Voltaren Arthritis Pain gel.

• Fewer Systemic Risks: Unlike oral NSAIDs, topical formulations reduce the risk of gastrointestinal, kidney, and cardiovascular side effects.

• Not for All Pain: Topical NSAIDs are most effective for superficial pain, like arthritis in the hands or knees, and are not suitable for deep or widespread pain.

• Know the Difference: NSAID creams are different from counterirritant creams (e.g., menthol) and numbing creams (e.g., lidocaine), which work by masking pain rather than reducing inflammation.

• Consult a Professional: Always talk to a doctor or pharmacist before using a topical NSAID, especially if you have other health conditions or allergies to oral NSAIDs.

Understanding the Action of NSAID Creams

What are NSAIDs and how do topical forms work?

NSAIDs, or nonsteroidal anti-inflammatory drugs, are a class of medications that work by inhibiting cyclooxygenase (COX) enzymes, which are responsible for producing prostaglandins. Prostaglandins are hormone-like substances that play a key role in the body's inflammatory response, causing pain, swelling, and redness. By blocking these enzymes, NSAIDs effectively reduce inflammation and, as a result, alleviate pain.

Topical NSAIDs are formulated to be applied directly to the skin over the site of pain, such as an inflamed joint or a strained muscle. This method of delivery allows the medication to concentrate in the underlying tissues, producing a localized effect. A major advantage of this approach is that only a small fraction of the drug is absorbed into the bloodstream compared to taking an oral NSAID. This significantly reduces the risk of systemic side effects, such as stomach upset, ulcers, or cardiovascular complications, which can be associated with long-term oral NSAID use.

Key ingredients to look for

The most prominent topical NSAID in the United States is diclofenac, available both over-the-counter (OTC) and by prescription. Other NSAID compounds, such as ibuprofen and ketoprofen, are also used in topical preparations in other countries and may be available via specialty compounding pharmacies in the U.S. The specific active ingredient, its concentration, and the carrier (gel, cream, patch) all influence the drug's effectiveness and absorption.

Common NSAID Creams and Gels

Diclofenac (Voltaren Arthritis Pain, others)

Diclofenac is the primary topical NSAID available in the U.S. for pain relief. It comes in various formulations and strengths for different uses:

• Diclofenac Sodium Topical Gel 1% (e.g., Voltaren Arthritis Pain): An over-the-counter product used to temporarily relieve arthritis pain in smaller joints like the hands, wrists, elbows, feet, ankles, and knees. It is not for immediate relief and may take up to a week to achieve the full effect.
• Diclofenac Sodium Topical Solution 1.5% and 2% (e.g., Pennsaid): Prescription-only formulations typically used for osteoarthritis pain in the knees.
• Diclofenac Epolamine Topical System 1.3% (e.g., Flector, Licart): A prescription patch used for the management of acute pain from minor strains and bruises.

Compounded Topical NSAIDs

While not commonly found in standard OTC creams, other NSAIDs can be specially compounded into topical formulations. In many European countries, for example, ibuprofen gels are readily available OTC. For specific conditions or for patients with sensitivities, a doctor might prescribe a compounded topical containing ibuprofen, ketoprofen, or other NSAIDs, often with a different base to improve skin penetration or reduce irritation.

Topical NSAIDs vs. Other Pain Relief Creams

When browsing the pain relief aisle, it's easy to confuse NSAID creams with other topical products. Understanding the difference is crucial for effective treatment. Unlike NSAID creams, which reduce underlying inflammation, other creams rely on different mechanisms to mask or block pain signals.

• Counterirritants: These products, like those containing menthol, camphor, or methyl salicylate (e.g., Icy Hot, Tiger Balm, Bengay), work by creating a hot or cold sensation that distracts from the pain. They do not address inflammation. Salicylates are chemically related to aspirin, but in these topical forms, they function primarily as irritants.
• Numbing Agents: Creams with lidocaine (e.g., some Aspercreme products) are topical anesthetics that numb the skin and block nerve pain signals. They do not affect inflammation.
• Capsaicin: This ingredient from chili peppers works by depleting a nerve's pain signals over time. It can cause a burning sensation and is often used for nerve pain rather than typical muscle or joint inflammation.

Benefits and Risks of Topical NSAIDs

Advantages of using NSAID creams

• Targeted Relief: Topical NSAIDs can be applied directly to the source of pain, delivering a high concentration of the active ingredient exactly where it's needed.
• Reduced Systemic Risk: The minimal absorption into the bloodstream significantly lowers the risk of serious side effects, such as gastrointestinal bleeding or cardiovascular issues, especially in comparison to oral NSAIDs. This makes them a preferred option for many individuals, including the elderly.
• First-line Treatment for Localized Pain: Clinical guidelines from organizations like the National Institute for Health and Care Excellence (NICE) recommend topical NSAIDs as a first-line treatment for pain from hand and knee osteoarthritis.

Potential risks and side effects

While generally safer than oral versions, topical NSAIDs still carry some risks:

• Local Skin Reactions: The most common side effects are mild skin reactions at the application site, including dryness, redness, itching, or rash.
• Systemic Absorption Risk: Even with topical application, some systemic absorption occurs. Individuals with pre-existing conditions like kidney disease, heart failure, or a history of stomach ulcers should still use caution and consult a doctor.
• Allergic Reactions: Individuals with an allergy to aspirin or oral NSAIDs can have a severe allergic reaction to a topical NSAID.
• Sun Sensitivity: Diclofenac can make skin more sensitive to sunlight, so treated areas should be protected from sun exposure.

Choosing the Right Pain Relief Cream

Choosing between different topical pain relievers depends on the type of pain and your health profile. The following table provides a comparison to help you make an informed decision.

Feature	Topical NSAID Creams	Counterirritant Creams	Lidocaine Creams
Active Ingredient	Diclofenac (Voltaren), sometimes compounded Ibuprofen or Ketoprofen	Menthol, Camphor, Methyl Salicylate	Lidocaine
Mechanism of Action	Inhibits COX enzymes to reduce inflammation and pain directly at the source.	Produces a distracting cooling or warming sensation; does not reduce inflammation.	Numb the skin and block nerve signals that transmit pain.
Primary Use	Localized pain from arthritis, strains, and sprains.	Temporary relief for minor muscle aches and soreness.	Numbing for localized nerve pain or skin surface discomfort.
Systemic Absorption	Minimal, leading to a better safety profile compared to oral NSAIDs.	Negligible for therapeutic effect, though salicylates can be absorbed.	Very little, but potential for absorption with large-area use.
Primary Side Effects	Local skin irritation (rash, dryness), potential for systemic issues with overuse.	Skin irritation, sensitivity, burning sensation.	Skin irritation, stinging, or redness at the application site.

How to Use NSAID Creams Safely

To maximize effectiveness and minimize risk, follow these best practices when using an NSAID cream:

1. Consult a Doctor: Before starting, especially if you have a pre-existing medical condition, are pregnant, or take other medications.
2. Use as Directed: Follow the dosing instructions provided on the packaging or by your pharmacist. Overuse can increase the risk of side effects.
3. Apply to Clean, Dry Skin: Ensure the area is free from cuts, rashes, or open wounds.
4. Avoid Other Products: Do not apply other topical products like sunscreen or lotion to the same area unless approved by your doctor.
5. Be Patient: For arthritis pain, topical NSAIDs like diclofenac gel may take up to 7 days to provide the full benefit.
6. Protect from Sun: Guard treated areas from sunlight to avoid photosensitivity reactions.

Conclusion: The Role of NSAID Creams in Pain Management

Topical NSAID creams, primarily those containing diclofenac, offer a valuable alternative for managing localized musculoskeletal pain, especially for conditions like arthritis, sprains, and strains. By providing targeted relief with minimal systemic absorption, they bypass many of the risks associated with oral NSAID medication. However, it is important to differentiate them from other topical pain relievers, use them strictly as directed, and consult a healthcare provider, especially if you have underlying health concerns or allergies. With proper use, these creams can be an effective and safe tool in your pain management strategy.

For more detailed information, consult the patient guide on diclofenac provided by MedlinePlus.

Frequently Asked Questions

Is Voltaren gel an NSAID cream?

Yes, Voltaren Arthritis Pain gel is a topical NSAID. Its active ingredient is diclofenac sodium, which works by reducing inflammation and pain in joints.

Do you need a prescription for NSAID creams?

Some NSAID creams, like Voltaren Arthritis Pain gel (diclofenac sodium 1%), are available over-the-counter. Stronger formulations, such as diclofenac topical solutions or patches, often require a prescription.

Can I use an NSAID cream for a sprain?

Yes, topical NSAIDs are commonly used for acute musculoskeletal pain from injuries like sprains and strains. They are effective in providing localized pain relief by reducing inflammation in the affected soft tissues.

How do topical NSAID creams differ from products containing menthol?

NSAID creams like Voltaren reduce inflammation at the source, while menthol creams are counterirritants that create a distracting hot or cold sensation on the skin's surface but do not address the underlying inflammation.

How long does it take for a topical NSAID to work for arthritis pain?

For arthritis pain, it may take up to seven days of consistent use to experience the full benefits of a topical diclofenac gel. It is not intended for immediate relief.

Who should avoid using topical NSAID creams?

Individuals with a known allergy to aspirin or other NSAIDs, those with a history of heart conditions, severe kidney or liver disease, or a history of stomach ulcers should consult a doctor before use. Pregnant women, especially after 20 weeks, should also avoid them.

Can I use a heating pad or bandage over an NSAID cream?

No, it is not recommended to use external heat sources like heating pads or apply a bandage over the treated area unless specifically instructed by a doctor. This can increase the amount of medication absorbed and raise the risk of side effects.