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FOR THE FASTEST and safest relief for pain, particularly that caused by osteoarthritis, many turn to Voltaren. Don’t know it? That’s because in the U.S. this ibuprofen-like gel is unavailable without a prescription. Having a tube on hand to try before or instead of seeking medical attention requires planning ahead, importuning your doctor for a Voltaren Rx just in case.
Alternatively, you can buy a few tubes—around $10 each—when traveling to another country like Canada, although take care when returning through Customs. Some Canadian pharmacies handle prescriptions online, although shipping costs add up, and this route can be unreliable as well as illegal. The FDA web site warns: “Don’t purchase from foreign web sites at this time because generally it will be illegal,” the word generally inspiring both guffaws and online orders.
Voltaren is diclofenac, an NSAID (non-steroidal anti-inflammatory drug) that blocks the immune system’s inflammatory response to injury, pain and stress on bones, joints and muscles. (Voltaren also comes as a patch to treat acute pain of strains, sprains and bruises, though obtaining these is also complicated.) Topical NSAIDs work best for short-term use, under four weeks.
Of four kinds of OTC pain medication, acetaminophen (Tylenol) is good for treating fever and most pain but less effective for musculoskeletal pain, and risks liver damage compared to the others: aspirin, ibuprofen and naproxen (Aleve). These three NSAIDs treat inflammation as well as pain and fever, but can risk irritating the GI tract, especially aspirin.
Rather than a “gut burner,” Voltaren gel can (for about 5% of patients) be a “skin burner,” causing redness at the site of application. By reducing exposure to the rest of the body, however, topical NSAIDS lower the risks of serious side effects, in particular those related to blood clotting.
Popular topical treatments, including salicylates (BenGay, Aspercreme) and capsaicin, along with the homeopathic Arnica montana (Traumeel), “have shown little potential in the past,” according to Paul Ingraham, creator of PainScience.com. Ingraham can buy Voltaren gel from “a rack of tubes…by the till at my neighborhood drugstore” in Vancouver.
Pain-killing gel, he explains, is most helpful for “accessible” joints, those not covered by a thick layer of muscle (like the shoulder), because “the medication gets diluted as it penetrates deeper into tissue.” Among conditions that gel can help: plantar fasciitis, shin splints, tendinitis where the tendon is just under the skin—in the elbow, Achilles, knees and fingers (carpal tunnel syndrome)—strains and bursitis.
“Surprisingly, Voltaren may even help some kinds of deep back pain,” Ingraham writes. In most cases, however, topicals don’t work well for deep tissue pain like muscle soreness, nor for conditions causing little or no inflammation. With repetitive strain injuries like tendinitis, there can be some inflammation, but “the chemistry is complex,” explains Ingraham. Generally, muscle pain in the low back, the neck and deeper in the body is unrelated to inflammation and thus unresponsive to topical gels.
In a Cochrane “systematic review” of current literature (61 studies, 8386 patients) that looked at patient improvement around 7 days after the injury—the accepted wisdom being that after that time most get better without treatment—diclofenac gel reduced pain for 7 or 8 of 10 patients, compared with 2 to 3 out of 10 with a placebo.
In the review, gel formulations of diclofenac, ibuprofen and ketoprofen, and some diclofenac patches provided the best effects for “painful strain, sprain or muscle pull.” About one in 20 had redness at the application site.
While U.S. residents await OTC Voltaren gel, researchers at the University of Warwick (England) have created an ibuprofen patch that can deliver a consistent high dose at a steady rate over about 12 hours. According to early results, this patch “opens the way for development of a range of novel long-acting, over-the-counter pain relief products” to treat common painful conditions without the side-effects of oral drugs, according to Science Daily.
Marketing of the new patch is expected to begin by the end of 2017. The question remains, however, about how many additional years U.S. residents will be obliged to wait—and could inspire future travel plans to Canada.
—Mary Carpenter
Mary Carpenter is the well-being editor of MyLittleBird. Read more of her posts here.