The main advantage of topical NSAIDs is the reduced exposure of the rest of the body to the product, which reduces the side effect profile. Given the toxicity of NSAIDs is related in part to the dose, it follows that topical treatments should have a better toxicity profile. Consequently, the cardiovascular risks of topical diclofenac, even in those with a high baseline risk of disease, should be negligible with the topical forms.

Voltaren® Gel (topical diclofenac) is a particularly safe and useful medicine. It’s an anti-inflammatory cream, so it can be applied only where you need it, instead of soaking your entire system with a medication, avoiding or dramatically reducing common side effects like indigestion, as well as some serious safety concerns associated with oral diclofenac. In the US, this drug is FDA-approved to treat osteoarthritis in “joints amenable to topical treatment, such as the knees and those of the hands,” but it probably also works for some other painful problems, such as some repetitive strain injuries and back pain. The evidence shows that it “provides clinically meaningful analgesia.” So this product actually works and gets a pass from skeptics and critics — a rare thing in the world of pain treatments!


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).
If you’re sensitive to aspirin, or if you’re taking any over-the-counter (OTC) anti-inflammatory drugs (like aspirin, ibuprofen, or naproxen), you should avoid willow bark. You should also avoid taking it if you’re taking warfarin (Coumadin) or other anticoagulant treatments, as salicin could increase the risk of bleeding. Talk to your doctor before taking willow bark if you’re taking other anti-inflammatory or pain medications.
I am a science writer and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I was the Assistant Editor of ScienceBasedMedicine.org for several years. I’ve written hundreds of articles and several books, and I’m known for readable but heavily referenced analysis, with a touch of sass. I am a runner and ultimate player. • more about me • more about PainScience.com
Also referred to as "hypnosis," hypnotherapy is a mind-body technique that involves entering a trance-like state of deep relaxation and concentration. When undergoing hypnotherapy, patients are thought to be more open to suggestion. As such, hypnotherapy is often used to effect change in behaviors thought to contribute to health problems (including chronic pain).
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.
Non-steroidal anti-inflammatory drugs (NSAID) are such effective pain killers that ibuprofen gel was originally only available on prescription. They are now widely available for self purchase and much better for your health than taking the same non-steroidal anti-inflammatory painkillers by mouth. NSAID pain relieving gels do not cause the same level of side effects as the oral versions, such as indigestion and heartburn. You do need to follow the in-pack instructions, however, and take care not to apply too much. In some cases, overuse of ibuprofen gel can increase your blood pressure.

NSAIDs such as topical diclofenac (Pennsaid, Voltaren) may cause swelling, ulcers, bleeding, or holes in the stomach or intestine. These problems may develop at any time during treatment, may happen without warning symptoms, and may cause death. The risk may be higher for people who use NSAIDs for a long time, are older in age, have poor health, smoke, or drink alcohol while using topical diclofenac. Tell your doctor if you have any of these risk factors and if you have or have ever had ulcersor bleeding in your stomach or intestines, or other bleeding disorders. Tell your doctor if you take any of the following medications: anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven); aspirin; other NSAIDs such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn); oral steroids such as dexamethasone, methylprednisolone (Medrol), and prednisone (Rayos); selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluoxetine (Prozac, Sarafem, Selfemra, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Paxil, Pexeva), and sertraline (Zoloft); or serotonin norepinephrine reuptake inhibitors (SNRIs) such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), and venlafaxine (Effexor XR). If you experience any of the following symptoms, stop using topical diclofenac and call your doctor: stomach pain, heartburn, vomiting a substance that is bloody or looks like coffee grounds, blood in the stool,or black and tarry stools.

Zeng C, Wei J, Persson MS, et al. Relative efficacy and safety of topical non-steroidal anti-inflammatory drugs for osteoarthritis: a systematic review and network meta-analysis of randomised controlled trials and observational studies. Br J Sports Med. 2018 Feb. PubMed #29436380. “Topical NSAIDs were effective and safe for OA. Diclofenac patches may be the most effective topical NSAID for pain relief. No serious gastrointestinal and renal AEs were observed in trials or the general population.” BACK TO TEXT


Cognitive Behavioral Therapy (CBT). In CBT, a psychotherapist helps you identify problematic behaviors (like becoming less active or doing fewer fun activities in response to pain), negative thoughts (about self, others and the future) and feelings (depression, guilt, anxiety). This can increase your awareness of how problematic patterns develop and help you understand the connection between thought patterns and feelings. You are then trained in pain coping skills, such as relaxation techniques, imagery, and goal setting, encouraging you to have an active role in managing and controlling pain. CBT can increase your ability to control pain while acknowledging that there may be occasionally flares beyond your control.
Cetyl myristoleate (CMO) is a fatty acid, an ethylated esterified fatty acid derived from bovine tallow oil. Though it is similar to fish oil, it is made specifically to help joints through its action as a cellular lubricant. Clinical studies show CMO to be an effective natural anti inflammatory compound that promotes healthy joint function. It increases joint flexibility and range of motion by lubricating the joint at a cellular level. It works to decrease inflammation specifically in the joints and lubricate their movement. In other words, it increases the fluids that cushion the space between the joint bones. CMO is reported to effect change at the cellular level, within the cell membranes themselves. It assists in the reduction and prevention of breakdown in joint cartilage. This can be especially helpful for those suffering degenerative osteoarthritis. The Journal of Rheumatology reported on a double-blind study of patients with chronic knee osteoarthritis where the CMO group saw significant improvement while the placebo group saw none. In fact, the scientists were so impressed with the results they concluded CMO “may be an alternative to the use of non-steroidal anti-inflammatory drugs for treatment of osteoarthritis.”
Diclofenac is also available as a 3% gel (Solaraze; generic) that is applied to the skin to treat actinic keratosis (flat, scaly growths on the skin caused by too much sun exposure). This monograph only gives information about diclofenac gel (Voltaren) and liquid (Pennsaid) for osteoarthritis. If you are using diclofenac gel (Solaraze, generic) for actinic keratosis, read the monograph entitled diclofenac topical (actinic keratosis).
The human body’s natural response to injury results in inflammation-induced pain, swelling, and erythema. In order to reduce pain, anti-inflammatory agents such as NSAIDs act on the multiple inflammatory pathways, which, although often very effective, can have undesirable side effects such as gastric ulceration and, infrequently, myocardial infarction and stroke.

I’ve just emphasized that Voltaren is mainly appropriate for shallow inflammation, but there is some evidence that Voltaren might be able to “reach deeper.” This is hardly the stuff of medical certainty yet, but researchers Huang et al found that Voltaren treated pain coming from deep inside the spine, right in the centre.6 They concluded that it could be a “convenient and safe clinical intervention” for a few types of back pain. An anti-inflammatory gel will likely fail with many kinds of back pain, but there’s also virtually no down-side to trying. See my low back pain tutorial for extremely detailed information about medications for back pain.


My doctor reddened and paniced a bit when he took my B/P and blamed it on the tablets which I rarely took, but the gel had been increased due to a worsening scoliosis and and a damaged knee getting worse with age. Recent research states clearly that this is a serious side effect, and it was not just a small rise but one of 25-30 points on my normal B/P!!! It can also cause hardening of the arteries and eventually a heart attack.
Rannou F, Pelletier JP, Martel-Pelletier J. Efficacy and safety of topical NSAIDs in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Semin Arthritis Rheum. 2016 Feb;45(4 Suppl):S18–21. PubMed #26806189. “Topical NSAIDs have a moderate effect on pain relief, with efficacy similar to that of oral NSAIDs, with the advantage of a better risk:benefit ratio. In real-life studies, topical and oral NSAIDs demonstrate an equivalent effect on knee pain over 1 year of treatment, with fewer adverse events due to lower systemic absorption of topical NSAIDs compared with oral NSAIDs.” BACK TO TEXT
SAMe is one of the natural chemicals made within the body that science has been able to duplicate in a lab, and make into a supplement. Studies have shown SAMe supplementation to be comparable to the pain-relieving effects of Celebrex by the second month of taking the product, without the side effects. The SAMe chemical has a role in pain, depression, liver disease and has been shown effective when used for relieving the symptoms of osteoarthritis, fibromyalgia, bursitis, Alzheimer’s disease, multiple sclerosis (MS), migraine headache, depression and more, making it a great natural remedy for inflammation.
I am allergic to anti-inflammatory pills since they affect my stomach. I don't like the bad side effects they give either. So I look to topical anti-inflammatory cream to help when I have back, hip and/or shoulders sprains and strains. I have tried endless products: Penetrex, Aspercreme, Australian dream, Celadrin and so on. Out of these, Muscle Care works best for pain management. However, I do have some skin reactions to it so I have to give it a rest. When that happens, I use Topricin which works quite well. However, to me, SynthaFlex works as well, if not better. On top of that, it gives a strong cool menthol effect which Topricin doesn't. So when I overwork some muscles, I like to use SynthaFlex and/or Topricin. When my skin reactions calm down, I go back to using Muscle Care from time to time. I also use a roller to stretch which also helps. I hope this review gives others a better sense of what might work for them.
Wasabi is another spicy food with natural painkilling properties. Scientists are studying the isothiocyanates in wasabi as potential pain relievers. Researcher from University of California San Francisco made a recent discovery suggesting that isothiocyanates could block an inflammation receptor, making it a potentially important natural painkiller. (2)

I am allergic to anti-inflammatory pills since they affect my stomach. I don't like the bad side effects they give either. So I look to topical anti-inflammatory cream to help when I have back, hip and/or shoulders sprains and strains. I have tried endless products: Penetrex, Aspercreme, Australian dream, Celadrin and so on. Out of these, Muscle Care works best for pain management. However, I do have some skin reactions to it so I have to give it a rest. When that happens, I use Topricin which works quite well. However, to me, SynthaFlex works as well, if not better. On top of that, it gives a strong cool menthol effect which Topricin doesn't. So when I overwork some muscles, I like to use SynthaFlex and/or Topricin. When my skin reactions calm down, I go back to using Muscle Care from time to time. I also use a roller to stretch which also helps. I hope this review gives others a better sense of what might work for them.
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.
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).
Curcumin is the bioactive compound in turmeric that gives the herb its healing properties. It’s one of the safest anti-inflammatories you can take, and is an effective natural pain reliever too — even for severe pain. In fact, curcumin matches or outperforms ibuprofen, acetaminophen, and other over-the-counter painkillers without any side effects.[12]
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