Why can't I use Voltaren gel on my back?

October 5, 2025 •

4 min read

While Voltaren Arthritis Pain gel is an effective over-the-counter treatment for localized pain in specific joints like the hands and knees, its safety and efficacy have not been evaluated for use on the spine or back. This crucial distinction is the primary reason why you can't use Voltaren gel on your back.

Quick Summary

Voltaren gel is not recommended for the back due to specific FDA-approved usage instructions and increased risks of systemic side effects. Misuse on large areas can heighten the dangers associated with oral NSAIDs, including heart attack, stroke, and gastrointestinal bleeding.

Key Points

FDA Approval Limits: Voltaren Arthritis Pain gel is only FDA-approved for specific, superficial joints like the hands and knees, not for the large, deep structures of the back.
Increased Systemic Absorption: Applying the gel to a large area significantly increases diclofenac absorption into the bloodstream, raising risks associated with oral NSAIDs.
Risk of Serious Side Effects: Misuse can increase the risk of cardiovascular events (heart attack, stroke), gastrointestinal bleeding, and kidney or liver damage.
Depth of Pain: The gel is designed for superficial pain, but back pain often involves deeper structures that topical treatments cannot effectively reach.
Safer Alternatives Exist: Alternatives like physical therapy, oral pain relievers, heat/cold therapy, or other topical analgesics (e.g., lidocaine, capsaicin) are often safer and more effective for back pain.

The Official FDA Stance on Voltaren Gel for Back Pain

Voltaren Arthritis Pain gel (diclofenac sodium 1%) is a topical nonsteroidal anti-inflammatory drug (NSAID). The U.S. Food and Drug Administration (FDA) approved this formulation for a very specific purpose: the treatment of osteoarthritis pain in joints that are easily treated topically, such as the hands, wrists, elbows, feet, and knees. The official prescribing information explicitly states that Voltaren gel was not evaluated for use on the joints of the spine, hip, or shoulder. This regulatory guideline is based on extensive clinical trials and risk assessments that determine the safest and most effective use of a medication.

The large surface area of the back, combined with the complex musculature and deeper spinal structures, makes it an unsuitable target for a topical medication designed for smaller, more superficial joints. The manufacturer's instructions, based on FDA approval, are not arbitrary; they are the result of rigorous scientific testing. Diverging from these guidelines for a large, deep area like the back introduces unknown risks and potential for adverse effects that the medication is not designed to mitigate effectively.

Systemic Absorption and Increased Risks

One of the main advantages of topical diclofenac over oral NSAIDs is its ability to deliver the medication locally with minimal systemic (body-wide) absorption. This reduces the risk of serious side effects associated with NSAID use, such as cardiovascular events and gastrointestinal bleeding. However, this safety profile is dosage and application-dependent. Applying the gel to a large surface area like the entire back significantly increases the amount of diclofenac that is absorbed into the bloodstream, negating the low systemic exposure benefit.

Nonsteroidal anti-inflammatory drugs (NSAIDs) like diclofenac work by inhibiting cyclooxygenase (COX) enzymes, which are responsible for producing prostaglandins that cause pain and inflammation. While this mechanism is beneficial, it is also what leads to the potential for systemic side effects when absorbed in high concentrations. By using Voltaren gel on a large area, you risk increasing your systemic exposure to a level that can trigger these adverse reactions, including potentially fatal cardiovascular and gastrointestinal events. This risk is especially concerning for individuals with pre-existing conditions.

Potential Dangers of Systemic Absorption from Misuse

Applying Voltaren gel improperly on the back can significantly increase your risk of the following serious side effects associated with oral NSAIDs:

Cardiovascular thrombotic events: Increased risk of fatal heart attack or stroke, particularly in individuals with pre-existing heart disease or risk factors.
Gastrointestinal bleeding and perforation: Increased risk of serious and potentially fatal stomach or intestinal bleeding, ulceration, and perforation, especially in older adults.
Hepatotoxicity and Renal Toxicity: Potential for liver inflammation, damage, and elevation of liver enzymes. Likewise, overuse or use by those with kidney issues can lead to kidney toxicity and failure.
Increased Blood Pressure: NSAIDs can cause new or worsening high blood pressure.
Heart Failure and Edema: Risk of fluid retention and swelling, which can contribute to heart failure.

Comparison of Treatment Options for Back Pain


Treatment	Primary Use	Systemic Absorption	Major Risk Factors	Best For
Voltaren Gel (US)	Localized osteoarthritis pain (hands, knees)	Low (when used correctly)	Skin reactions at application site	Small, superficial joints
Oral NSAIDs (e.g., Ibuprofen)	Widespread pain and inflammation	High	GI bleeding, cardiovascular events, kidney damage	Generalized back pain (under MD supervision)
Physical Therapy	Rehabilitative therapy; strengthening and flexibility	None	Dependent on injury; potential for soreness	Chronic back pain, recovery, prevention
Heat/Cold Therapy	Muscle soreness, stiffness, acute injuries	None	Skin irritation, burns (if used improperly)	Acute muscle strains or chronic stiffness
Acetaminophen (e.g., Tylenol)	Mild to moderate pain, fever reducer	High	Liver damage (with overuse or specific conditions)	Mild back pain, especially in those with NSAID contraindications

Safer and More Effective Alternatives to Treat Back Pain

Because of the risks associated with misusing Voltaren gel, it is important to explore alternative treatments that are specifically designed for or proven effective against back pain. For over-the-counter options, oral NSAIDs like ibuprofen or naproxen can be used as directed for widespread muscle or joint pain, though they carry their own set of systemic risks. Other options include:

Oral Pain Relievers: Acetaminophen can be effective for mild to moderate pain, especially for those who cannot take NSAIDs due to stomach or heart issues.
Physical Therapy: A physical therapist can provide targeted exercises to strengthen core muscles, improve flexibility, and correct posture issues that contribute to back pain.
Topical Analgesics (Alternative): Creams or patches containing lidocaine or capsaicin are often used for back pain and work via different mechanisms, bypassing the systemic NSAID risks.
Heat and Cold Therapy: Applying a heating pad or a cold pack can provide significant relief for muscle soreness and inflammation.
Massage and Chiropractic Care: These therapies can help with muscle tension and spinal alignment issues that cause back pain.
Lifestyle Changes: Simple adjustments like regular exercise, maintaining a healthy weight, and practicing good posture can prevent and alleviate back pain long-term.

It is important to note that some regions, such as Canada, may have different formulations or approvals for Voltaren Emulgel products specifically marketed for back pain. However, the U.S. product (Voltaren Arthritis Pain) and its FDA guidelines are distinct and must be followed by U.S. consumers to ensure safety.

Conclusion

Ultimately, the reasons you can't use Voltaren gel on your back come down to both pharmacological limitations and regulatory safety. The gel's low systemic absorption, a key safety feature, is compromised when applied to a large surface area like the back, increasing the risk of serious side effects. Additionally, Voltaren was not evaluated for the complex, deep structures of the spine, and its efficacy for such use is unproven. Always consult a healthcare provider for a proper diagnosis and treatment plan for back pain, and consider safer, proven alternatives like physical therapy, heat/cold therapy, or oral pain relievers as directed. A discussion with a professional is the surest way to find effective and safe relief. For more information on proper medication usage and safety, you can consult resources like MedlinePlus.

Frequently Asked Questions

Voltaren Arthritis Pain gel is FDA-approved for the topical treatment of osteoarthritis pain in certain small joints, including the hands, wrists, elbows, feet, and knees.

Applying Voltaren gel to large areas like the back can increase the absorption of diclofenac into your bloodstream. This raises the risk of serious systemic side effects, such as heart attack, stroke, and gastrointestinal bleeding, which are typically associated with oral NSAID use.

Voltaren gel is formulated for localized, superficial pain. The complex and deep structures of the back are often beyond the reach of topical medication, making it less effective for many types of back pain.

Similar to the back, the manufacturer's prescribing information states that Voltaren gel has not been evaluated for use on the shoulder or hip. Use on these large joints is not recommended due to safety and absorption concerns.

Safe alternatives for back pain include physical therapy, heat and cold therapy, over-the-counter oral pain relievers (like ibuprofen or acetaminophen, used as directed), and other topical products containing lidocaine or capsaicin.

Yes, some other countries, like Canada, have different formulations or regulatory guidelines for Voltaren products. For example, some Canadian versions are marketed for back and muscle pain. However, U.S. consumers must follow the FDA guidelines for the specific product available in the U.S..

Yes, it is highly recommended to speak with a healthcare provider for any persistent or severe back pain. A doctor can provide an accurate diagnosis and recommend the safest and most effective treatment plan for your specific condition.