Arthritis pain: Treatments absorbed through your skin

After an active weekend of hiking or work around the yard, joints might continue to hurt even after taking arthritis pain medicine. Don't want to take another pill? Maybe a joint cream can dull the pain.

How do these products work? Can they relieve arthritis pain?

What are pain medicines that go on the skin, called topical?

Topical pain medicines soak through the skin. The most common types are creams or gels. You rub them onto the skin over painful joints. Some topical pain medicines come in patches that stick to the skin.

Because the medicine soaks through the skin, most topical pain products are best for joints that are close to the skin. These are the joints in hands and knees.

Topical nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a common treatment for osteoarthritis. But the kind you take by mouth, called oral NSAIDs, can cause stomach upset and heart problems. Topical nonsteroidal anti-inflammatory drugs, however, have a lower risk of both.

Several topical products (Voltaren Arthritis Pain, Pennsaid, others) are made with a nonsteroidal anti-inflammatory medicine called diclofenac. They treat osteoarthritis in joints that are close to the skin, such as the hands and knees. These products were once available only by prescription. But now you can get them without a prescription.

Some studies show that many nonsteroidal anti-inflammatory creams and gels work as well as oral nonsteroidal anti-inflammatory drugs. For older people or those who can't take nonsteroidal anti-inflammatory drugs by mouth, topical NSAIDs might be a good choice.

Topical nonsteroidal anti-inflammatory creams and gels can be used as needed or every day. They work best when combined with exercises prescribed by a health care professional. For knee osteoarthritis, weight loss also is important for anyone who's overweight.

Other topical arthritis products

Other topical treatments recommended for knee and hand osteoarthritis are those that have capsaicin (kap-SAY-ih-sin). Capsaicin causes the burning feeling that comes from chili peppers.

Examples include Capzasin-HP and Zostrix. Capsaicin blocks a chemical in the nerve cells that sends pain messages. Capsaicin works best if used several times a day. It might take up to two weeks to feel relief.

Other topical treatments you can get without a prescription include:

• Salicylates. Salicylates (suh-LIS-uh-lates) are what relieve pain in aspirin. Topical treatments with salicylates include Aspercreme and Bengay.
• Counterirritants. These make the skin feel hot or cold. Those feelings might block pain signals. Counterirritants might contain menthol or camphor. Examples include Icy Hot and Biofreeze.
• Anesthetics. Topical anesthetics such as lidocaine cause numbness. The numb feeling reduces pain. Lidocaine comes in a cream, gel, spray or patch. Examples include LidoPatch and Topicaine.

How well do topical products work?

Many people say topical products help relieve their arthritis pain. But research doesn't always show that they work well.

Compared with other products, topical nonsteroidal anti-inflammatory medicines have more studies that show that they work and are safe. The other products work only a little better or no better than the controls, called placebos, that are used in studies. Capsaicin might work better when used with other treatments, such as pills containing nonsteroidal anti-inflammatory drugs.

Are they safe to use?

Putting capsaicin creams on the skin can make the skin burn or sting. But this might get better within a few weeks of daily use.

If you use a product with capsaicin, wash your hands well after each use. Don't touch your eyes. You might need to wear latex gloves when putting on the cream.

Don't use any topical pain relievers on broken or irritated skin. Don't use them with a heating pad or bandage.

If you are allergic to aspirin or take blood thinners, talk with a member of your health care team before using topical medicines with salicylates.