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 bottom (anal) areas. Do not use plasters or bandages (dressings) 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.
The first generic (cheaper) equivalent of Voltaren® Gel entered the marketplace in 2016, produced by Amneal Pharmaceutical. It should be widely available now. Both products are still prescription-only in the US, but fortunately they are over-the-counter almost everywhere else (there’s a rack of tubes of Voltaren by the till at my neighbhourhood drugstore).

Schematic showing another inflammatory pathway that is activated by tissue injury. This is the NF-kB activation, in which once the protein is free as a result of tissue injury, it can enter the cell nucleus and activate the DNA to enhance the inflammatory response further by the production of additional cytokines, chemokines, and adhesion molecules (IKKB = IkB kinase)


The active ingredients in fish oil, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), enhance the conversion of COX to prostaglandin E3. A natural anti-inflammatory agent, prostaglandin E3 competitively inhibits the effects of the arachidonic acid conversion to prostaglandin E2, a highly inflammatory substance. Prostaglandin E3 also inhibits the synthesis of TNF-α and IL-1b, both of which are inflammatory cytokines. The EPA and DHA can inhibit the 5-LOX pathway, which converts arachidonic acid to inflammatory leukotrienes, by competitive inhibition as well. When EPA and DHA are incorporated into articular cartridge chondrocyte cell membranes, there is a dose-dependent decrease in the expression and activity of the proteoglycan-degrading aggrecanase enzymes.[12,23–25,27,50,85]

A physical therapist will teach you stretches to manage your back pain, as well as exercises to correct any imbalances that might have brought on pain in the first place. Depending on the causes and severity of your back pain, your PT may also employ other treatment techniques, such as ultrasound, electrical stimulation, and active release therapy.
The use of fish oil (in the form of cod liver oil), an omega-3 EFA, for the treatment of muscular, skeletal, and discogenic diseases, can be traced back to the late 18th century as detailed by Curtis et al.,[24,25] Unfortunately, because of the rapid onset of rancidity of this polyunsaturated oil when exposed to air, and hence its disconcerting odor, cod liver oil fell out of favor. With improved extraction techniques, such as using a protective nitrogen blanket and enhanced oxygen-free encapsulation methods, there is less chance of oxidation during the manufacturing process. The therapeutic benefits of fish oil can now be realized without the regurgitation and odor of previous products caused by peroxides and rancid tasting fish oil.[14]
Hi Brenda, The most effective painkilling gel is Voltarol which contains diclofenac, assuming your bad reaction to oral painkillers was not an allergy to NSAIDs. Another option to try is magnetic gloves, or a pain killing device such as Arc4Health, which can have quite miraculous painkilling effects. You should also ask your doctor to refer you to a pain clinic for specialist advice. I hope that helps. Best wishes, Sarah B

The Penetrex® inflammation formulations have received rave reviews on Amazon.com® since 2009. With the Penetrex® Pain Relief Cream you will need fewer applications, and it actually heals and repairs your problem without masking the pain. You can get around expensive prescription medications using this product. You will have no side effects and it is not addictive. The cream will increase and enhance your range of motion and flexibility when you have no pain to deal with.


For greater efficiency in using these types of products ensure that you by an anti-inflammatory cream that would not make you feel less comfortable when you are around other people. The best quality creams in such a case are the ones whose scent vanishes quickly with every application or the ones that would emit no scent thus allowing you to continue your daily life activities more proficiently with no distractions. The creams made of natural ingredients are the best quality you could ever buy because they are both efficient and would not leave you feeling less comfortable perhaps because of the irritating smell you may be forced to endure in the hopes of dealing with your pain or inflammation that may arise from an injury. Never spend your money on a product that would not serve your needs as desired because the very reason why we buy different products at different points in time is so that they could meet our needs if not then there would be no need of acquiring the product in the first place.

Even though you might need something for your pain or a product that would help minimize inflammations of any kind, the cream that you buy should come with greater convenience. The creams that have a no greasy feeling quality when used would be the ultimate choice you could ever make if you desire a medication that would be more comfortable and effective at the same time. The creams with no greasy feeling would mean that you would never stain your clothes with the ointment and most of all; you would be able to tackle the minor injuries you may be subjected to at different times in your life. If you are not sure of what to buy, make sure that you consult with your friends or family members who may have used some of these products at different times in their lives. If not, ensure that you talk to your doctor on the same issue since the physicians are more than capable of providing individuals with the best advice regarding the anti-inflammatory creams that would work better with no side effects whatsoever. With everything considered, what is important is acquiring a cream that is viable, reasonably priced, safe to use, and able to provide you with fast pain relief.
Capsaicin. Derived from hot chile peppers, topical capsaicin may be useful for some people in relieving pain. "Capsaicin works by depleting substance P, a compound that conveys the pain sensation from the peripheral to the central nervous system. It takes a couple of days for this to occur," says David Kiefer, MD, assistant clinical professor of medicine at the Arizona Center for Integrative Medicine.
It contains arnica, a wonderful pain reliever used by many massage therapists, vitamin B6 that makes red blood cells that produces neurotransmitters, homocysteine levels, and also makes the hormones serotonin and norepinephrine; it has pyridoxine; choline bitartrate cetyl myristoleate; MSM (methylsulfonlmethane) that helps with scars, stretch marks, and pain; and has glucosamine, and boswellia serrata.
There's a reason there are so many roll-ons on this list. They're super handy and easy to use. This CobraZol gel provides quick relief that lasts up to 10 hours. It's a good choice for both chronic and acute pain. This gel comes in a 2 oz format. Believe it or not, this stuff actually contains cobra venom. Venom apparently is thought to help de-active pain pathways and reduce pain. This roll-on is a great way to manage pain and help users wean off of more serious and potentially dangerous pain medications.
Arnica is a natural anti-inflammatory, which is why you’ll find it in many pain relief gels and creams. It is a powerful natural medicine that comes from the perennial flower Arnica Montana. It that makes natural quick and easy pain relief possible, and it is also one of the biggest reasons why most pain relief gels and creams that use Arnica are available over the counter without a prescription or a doctor’s visit.
The available science includes a 2011 study published in Arthritis Care & Research, which found that a 10-week tai chi program reduced pain and improved functioning in people with long-term low back pain symptoms. The study involved 160 adults with chronic low back pain, half of whom participated in 40-minute-long tai chi sessions 18 times over the 10-week period.
Today, the most common conventional treatments for lower back pain relief are medications, including NSAIDS like aspirin and Tylenol, along with more potent prescription painkillers, such analgesics. These drugs can potentially cause adverse side effects in some patients and commonly don’t solve the underlying causes of lower back pain (such as poor posture, obesity or exercise-related strains). Some medications for back pains have even been tied to complications, such as liver damage or intestinal bleeding, when taken for long periods of time or in high doses.

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Research shows that applying celadrin cetylated fatty acid cream with menthol to knees can reduce arthritis pain and improve the range of movement. Applying celadrin cream also makes it easier to climb up and down stairs. Celadrin cream cetylated fatty acids is also effective as a muscle pain relief cream to treat pain associated with trigger points in the neck.
Veritas Health publishes original and accessible health related content written by more than 100 physician authors and peer-reviewed by a 16 member Medical Advisory Board. The Veritas Health platform comprising of Spine-health.com, Arthritis-health.com, Sports-health.com, and Pain-health.com, provides comprehensive information on back pain, arthritis, sports injuries, and chronic pain conditions. For more information visit Veritashealth.com.
With more than 23,000 reviews on Amazon, customers give Penetrex sky-high marks for effective pain relief. If it doesn’t work for you, it comes with a 100 percent, no-questions-asked, money-back guarantee. Formulated to fight inflammation, it contains a mix of ingredients including arnica, choline, glucosamine, Vitamin B6, and MSM. It’s not odor-free, but rather has a light scent that disappears quickly after you apply it. You can use it alone or in conjunction with heating pads, massagers, ice, and other therapies.
Capsaicin creams are another topical option for pain relief. These contain the active component in chili peppers that cause a burning sensation. I know its sounds like this would cause more pain, but in fact the low levels of capsaicin in these creams block pain by temporarily depleting the nerves of certain chemicals that transmit pain impulses. Application of this cream three times daily was shown to significantly improve pain scores for fibromyalgia in one study done in Spain.
Since the time of Hippocrates white willow bark has been in use as a natural means of reducing inflammation and pain, specifically associated with osteoarthritis and rheumatoid arthritis, as well as headache, backache, gout and PMS. The bark of the willow tree contains the chemical salicin, which has a similar effect in the body as acetylsalicylic acid (aspirin). But it’s better than aspirin, because it has none of the gastrointestinal side effects, and it naturally contains flavonoids (anti-inflammatory compounds found in plants).
Acupuncture: Acupuncture may provide even more relief than painkillers, according to one 2013 review. In 11 studies of more than 1,100 people, this Chinese medicine staple improved symptoms of lower back pain better than simulated treatments and, yes, in some cases, NSAIDs. The needles appear to change the way your nerves react and may reduce inflammation around joints (which is only one of the therapy's benefits), says DeStefano.

When anti-inflammatories are taken by mouth they work by blocking (inhibiting) the effect of chemicals (enzymes) 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.
Staying in bed for any prolonged period can make you stiff and increase pain. When you don’t move and bend, you lose muscle strength and flexibility. With bed rest, you lose about 1 percent of your muscle strength each day. And you can lose 20 to 30 percent in a week. It becomes more difficult to return to any activity. As you become weaker and stiffer your recovery takes longer.
It seems to be a goal for those people with chronic pain to spend a day without the pains and aches. They are ready to do anything to manage their pain. These people have tried nearly everything to get relief from pain including extremely addictive and potent prescription drugs, surgery with several dangerous side effects. They also try to herbal, homeopathic, acupuncture and many other remedies. In truth, there are some creams may be dangerous and toxic to your health. Sometimes pain relief cream is not the solution of all pains due to their toxic side effects. So, how do we make sure that the cream we choose is safe?

"There are three that I swear by. I use Icy Hot Roll-On ($5; walmart.com) on my feet at the end of the day after I do my exercises to stretch my feet. It's also great for traveling because it doesn't get messy! I like Salonpas Spray ($8; walmart.com) because it can get hard-to-reach places on my back or shoulder blades. And since Tiger Balm ($5; walmart.com) is strong, I use that when my legs are sore and I sleep with it on. I wake up the next morning and feel great." —Nicole Winhoffer, founder NW Method

Bark from the white willow tree is one of the oldest herbal remedies for pain and inflammation, dating back to ancient Egyptian, Roman, Greek, and Indian civilizations, as an analgesic and antipyretic agent. Because of the gastric side effects of aspirin, there has been a resurgence in the use of white willow bark for the treatment of inflammatory syndromes. The mechanism of action of white willow bark is similar to that of aspirin which is a nonselective inhibitor of COX-1 and COX-2, used to block inflammatory prostaglandins.[48]
A 2008 study published in the journal Spine found "strong evidence that acupuncture can be a useful supplement to other forms of conventional therapy" for low back pain. After analyzing 23 clinical trials with a total of 6,359 patients, the study authors also found "moderate evidence that acupuncture is more effective than no treatment" in relief of back pain.
Diclofenac sodium 1% gel (Voltaren, also available as a generic). When used for osteoarthritis pain of the hands, elbows or wrists, apply 2 grams to each affected area four times a day (a total of 8 grams per day). When used on knees, ankles, or feet, apply 4 grams to each affected area four times a day (a total of 16 grams per day).  However, the total amount used on your body should not exceed 32 grams per day. A dosing card comes with the gel so you can measure the correct amount.
To avoid unwanted weight gain, consuming inflammatory ingredients or complications due to nutrient deficiencies, reduce or eliminate the following foods: added sugar, sweetened beverages or snacks, refined vegetable oils, refined grain products, too much alcohol and tobacco products (smoking impairs blood flow and adds to nutrient deprivation to spinal tissues).

In the case of topical creams, many individuals may suffer from allergies that they weren't even aware of until they encounter a negative reaction. These reactions can range in severity from mild skin irritation to more severe issues such as inflammation and increased pain. Remember to check all the ingredients for any topical medication you buy in order to avoid potential allergens and irritants.


Capsicum is an extract from the chilli or cayenne pepper which reduces pain by continuously stimulating nerve endings in the skin at a very low-level. This depletes nerve endings of neurotransmitter chemicals so they become less sensitive and pass on fewer pain messages to the brain. Those messages that are passed on tend to get screened out as they brain shuts off distracting, low-level irritation. Ingredients that do this are known as ‘counterirritants’. These effects also reduce sensation from underlying painful joints. See the best capsicum containing rubs at Amazon.co.uk or Amazon.com. Warning! These are HOT to use, but really relieve muscle and joint pain. Wash your hands thoroughly after use and do them rub your eyes by mistake during use.

Synovial fluid is a thick, slippery substance with a consistency similar to egg white. It acts like an oil and fills small cavities within the joint cartilage, providing oxygen and nutrients when the joint is resting. Synovial fluid also pushes the bones apart so they don’t rub together to cause pain. Glucosamine also provides building blocks for making new cartilage, and repairing damaged areas. Glucosamine is also known to damp down inflammation and act as a biological signal to stimulate tissue repair.


8. Capsaicin (Capsicum) – Found in hot chile peppers, this natural remedy does wonders for pain. Capsaicin, the active pain-reducing ingredient, temporarily desensitizes nerve receptors called C-fibers which cause the pain response. Capsaicin also diminishes soreness for 3 to 5 weeks while the C-fibers regain sensation. A single 60-min application in patients with neuropathic pain produced effective pain relief for up to 12 weeks. Patients at the New England Center for Headache decreased their migraine and cluster headache intensity by applying capsaicin cream to their nasal passages.
I’m often asked which is the strongest ibuprofen gel. If you’re looking for the best muscle pain relief, however, I recommend diclofenac gel rather than ibuprofen gel. Research shows that diclofenac gel (Voltarol) is stronger and more effective than even a strong ibuprofen gel. If you still prefer to use an ibuprofen gel, however, you can find them on Boots.com.
When anti-inflammatories are taken by mouth they work by blocking (inhibiting) the effect of chemicals (enzymes) 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.
Capsaicin cream, also called capsicum cream, is available in drug stores, health food stores, and online. A typical dosage is 0.025% capsaicin cream applied four times a day. The most common side effect is a stinging or burning sensation in the area. If possible, wear disposable gloves (available at drugstores) before applying the cream. Be careful not to touch the eye area or open skin. A tube or jar of capsaicin cream typically costs between $8 and $25.
Low back pain and neck pain often involve a substantial amount of muscle pain,22 and muscle pain is not particularly inflammatory by nature. Muscle knots (trigger points) are more like poisoned muscle than injured muscle. Although there’s some anecdotal evidence that taking an anti-inflammatory medication reduces muscle pain, mostly it doesn’t seem to work very well. One of the classic signs of low back pain powered by muscle, for instance, is that ibuprofen doesn’t have much effect!
Hallie Levine is an award-winning magazine and freelance writer who contributes to Consumer Reports on health and fitness topics. Her work has been published in Health, Prevention, Reader's Digest, and Parents, among others. She's a mom to three kids and a fat but feisty black Labrador Retriever named Ivry. In her (nonexistent) spare time, she likes to read, swim, and run marathons.
Foam roller exercises are a form of self-myofascial release that, while kind of mildly painful at times, actually gets out those nagging muscle knots while helping you fix muscle imbalances that lead to poor posture and related musculoskeletal pain. It’s also an emerging treatment to reduce your risk of developing delayed muscle onset soreness, a common exercise-related pain that keeps people out of the gym. (6)

Hi Bob, Naproxen is an anti-inflammatory (NSAID) that is working from the inside, so ideally you want a cream or gel that works in a different way to gain opimum benefits (otherwise I would recommend Voltarol Pain Relief Gel which contains another NSAID called diclofenac). Movelat contains salicylic acid, which is a weaker NSAID than Naproxen so it may not provide much additional relief. I find Celadrin cream works well. Hope your pain improves soon. Best wishes, Sarah B
Nonsteroidal anti-inflammatory drugs (NSAIDs) have shown efficacy in patients with osteoarthritis (OA) pain but are also associated with a dose-dependent risk of gastrointestinal, cardiovascular, hematologic, hepatic, and renal adverse events (AEs). Topical NSAIDs were developed to provide analgesia similar to their oral counterparts with less systemic exposure and fewer serious AEs. Topical NSAIDs have long been available in Europe for the management of OA, and guidelines of the European League Against Rheumatism and the Osteoarthritis Research Society International specify that topical NSAIDs are preferred over oral NSAIDs for patients with knee or hand OA of mild-to-moderate severity, few affected joints, and/or a history of sensitivity to oral NSAIDs.

While these are not the only risks NSAID medications, they are somewhat more common, and some of the more worrisome, side effects. It is always safest to have a discussion with your physician if you have any concerns about the risk of taking these medications. It is important to understand that even in healthy people without underlying medical conditions, there is always the risk associated with any medication. The benefits of taking an anti-inflammatory medication need to be balanced with the possible risks of taking the medication.

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Achy back? You're not alone: back problems send more Americans to the doctor annually than nearly any other medical problem, according to a 2013 Mayo Clinic study. Whether you're recovering from misjudging a heavy load (we've all been there), dealing with a lingering injury, or have a chronic problem, you don't necessarily need to resort to popping tons of pain relievers. Talk to your doc about these 15 expert-approved natural back pain remedies, and find out if they are safe and appropriate for you.
5. Birch Leaf (Betula Lenta) – The leaves from the Birch tree act much like cortisone, a prescription drug used to treat endocrine disorders, arthritis, lupus, skin disease, autoimmune disorders, and more. A main chemical compound found in Birch leaves is methyl salicylate, similar to salicylic acid used in aspirin. It is anti-spasmodic, analgesic, astringent, antifungal, diuretic, detoxifying, reduces oxidative damage to skin (stopping wrinkles), and enhances circulation. It also promotes enzymatic secretions in the body. It is truly one of the first powerful pain-relievers ever used.

The first is that inflammation-lowering NSAIDs destroy your gut lining. Check the bottle of ibuprofen or aspirin in your medicine cabinet. You’ll see it right on the label: “NSAIDs such as ibuprofen may cause ulcers, bleeding, or holes in the stomach and/or intestine.”[1] Long-term low-dose aspirin use is particularly likely to cause ulcers and tear holes in your intestine.[2]

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