What are topical anti-inflammatory painkillers?
Anti-inflammatory painkillers are a group of medicines that are used to ease muscle pains, sprains, strains, and arthritis. They can be taken by mouth (tablets, capsules or liquids), injected, or applied to the skin. When they are applied to the skin they are called topical anti-inflammatory painkillers. Sometimes they are called ‘topical non-steroidal anti-inflammatory drugs’ (NSAIDs), or just ‘topical anti-inflammatories’.
Topical anti-inflammatories are available as gels, gel patches, sprays, or foams. They contain an anti-inflammatory medicine such as ibuprofen, diclofenac, felbinac, ketoprofen, or piroxicam and come in various different brand names.
Other creams and ointments are available to ease muscle pains, strains, and sprains – for example, capsaicin. However, this leaflet only discusses topical anti-inflammatory medicines.
For information on anti-inflammatory medicines taken by mouth or injected, see separate leaflet called ‘Anti-inflammatory Painkillers’.
How do topical anti-inflammatory painkillers work?
When anti-inflammatories are taken by mouth they work by inhibiting (blocking) the effect of enzymes (chemicals) called cyclo-oxygenase (COX) enzymes. COX enzymes help to make other chemicals called prostaglandins. Some prostaglandins are involved in the production of pain and inflammation at sites of injury or damage. A reduction in prostaglandin production reduces pain and inflammation.
Topical anti-inflammatories work in the same way but, instead of having an effect on all of the body, they only work on the area that you have applied them to. When they are applied they are absorbed into your skin and then move deeper into areas of the body where there is inflammation (for example, your muscle). They relieve pain and reduce swelling affecting joints and muscles when rubbed into the skin over the affected area. Using a topical preparation means that the total amount of anti-inflammatory in your body is very low. This in turn means that you are much less likely to have a side-effect to this medicine.
When are topical anti-inflammatory painkillers usually prescribed?
Topical anti-inflammatories are usually prescribed if you have muscular pains, sprains and strains. They can also be used to help ease pain caused by osteoarthritis in the knee or hand.
They are sometimes prescribed instead of oral anti-inflammatory medicines because they have fewer side-effects.
How well do topical anti-inflammatory painkillers work?
Topical anti-inflammatories work well to treat acute muscular pain and inflammation. Quite a number of studies show that, if 10 people use a topical anti-inflammatory for seven days, about 6 or 7 people will have good pain control. However, the same studies show that some people also have a good response to a dummy cream or gel (does not contain any medicine); if you give 10 people a dummy cream or gel for seven days, four people will have good pain control. It is thought that this is because most sprains and strains get better on their own over time.
There is debate as to how effective topical anti-inflammatories are compared to tablets. Some studies suggest that they may be as good as tablets for treating sprains. Some studies suggest they may not be as good. However, the amount of the medicine that gets into the bloodstream is much less than with tablets, and there is less risk of side-effects.
When using topical anti-inflammatory painkillers
Some important considerations are:
- How to apply
- How much to apply
- Sensitivity to light
How to apply
Apply to the affected area, and massage into the skin gently. Always wash your hands after you have finished rubbing the cream, gel or spray into the skin. This is to make sure that you avoid rubbing this medicine into sensitive areas of the body such as the eyes. Do not apply to skin that is broken, or near the eyes, nose, mouth, genital or anal (bottom) areas. Do not use plasters or dressings (bandages) on top of these medicines. Generally these medicines are applied to the skin 2-4 times a day. However, for specific advice for your medicine, see the leaflet that comes inside the packet.
How much to apply
This varies a lot, and depends upon which cream, gel, or spray you have. Please read the instructions that came inside the packet of your medicine for more details.
Sensitivity to light
If you are using a topical anti-inflammatory there is a risk that your skin can become sensitive to light (photosensitivity). If you are using a preparation that contains ketoprofen you should cover the area of skin where ketoprofen has been applied (to protect it from sunlight). Also, you should not use a sunbed, or expose your skin to sunlight during treatment, and for two weeks after stopping.
What are the possible side effects?
Most people who use topical anti-inflammatory medicines do not have any side-effects. However, side-effects occur in a small number of users. The most common side-effect is a rash. If you develop a rash when using an anti-inflammatory then you should stop the treatment and ask your doctor or pharmacist for advice.
Some people have had an allergic reaction to these medicines – this is rare. Asthma has also been reported. However, these side-effects have happened when some people have applied very large amounts to their skin.
For a full list of side-effects and possible interactions associated with your medicine, consult the leaflet that comes with your medication.
Can I buy topical anti-inflammatory painkillers?
Yes – you can buy some topical anti-inflammatory medicines. For example, you can buy the smaller packs of ibuprofen gel, ketoprofen gel, and diclofenac gel.
What is the usual length of treatment?
This can vary depending on the reason for treating you, so speak to your doctor for advice. If you are using an anti-inflammatory for acute muscle pain then, usually, treatment lasts for as long as you have pain and inflammation – for example, a few days, or weeks. But if you are being treated for conditions like osteoarthritis, your doctor may advise you to use this medicine for the long term.
Who cannot use topical anti-inflammatory painkillers?
In general there are very few people who cannot use a topical anti-inflammatory.
You should not use a topical anti-inflammatory medicine if:
- You have had an allergic reaction to aspirin or any other oral anti-inflammatory medicine.
- You are asthmatic, or suffer from rhinitis (allergic runny nose) or urticaria (hives) and have ever had a bad reaction to aspirin, ibuprofen or other anti-inflammatory medicines.
- Your skin is broken, or damaged.
A full list of people who should not use a topical anti-inflammatory is included with the information leaflet that comes in the drug packet. If you are prescribed or buy a topical anti-inflammatory, read this to be sure you are safe to take it.
How to use the Yellow Card Scheme
If you think you have had a side-effect to one of your medicines, you can report this on the Yellow Card Scheme. You can do this online at the following web address: http://yellowcard.mhra.gov.uk
The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that your medicines may have caused. If you wish to report a side-effect, you will need to provide basic information about:
- The side-effect.
- The name of the medicine which you think caused it.
- Information about the person who had the side-effect.
- Your contact details as the reporter of the side-effect.
It is helpful if you have your medication and/or the leaflet that came with it with you while you fill out the report.
References and Disclaimer | Provide feedback
- British National Formulary; 62nd Edition (Sep 2011) British Medical Association and Royal Pharmaceutical Society of Great Britain, London (link to current BNF)
- Massey T, Derry S, Moore RA, et al; Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010 Jun 16;(6):CD007402. [abstract]
- Osteoarthritis, NICE Clinical Guideline (January 2008); The care and management of osteoarthritis in adults
- Cooper C, Jordan KM; Topical NSAIDs in osteoarthritis.; BMJ. 2004 Aug 7;329(7461):304-5.