published 10/01/09

Voltaren® Gel

A promising rub-on anti-inflammatory medication

by Paul Ingraham, Vancouver, Canada MORE

Credentials and qualifications

I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.

For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.

Think of Voltaren® Gel as ibuprofen in a gel. It’s a topical anti-inflammatory medication, and FDA-approved to treat osteoarthritis in “joints amenable to topical treatment, such as the knees and those of the hands.” The evidence shows that it “provides clinically meaningful analgesia.”1 This is an appealing treatment idea that actually works: what a pleasure to be able to say that!2

Funny how things like this slip through the cracks. I communicate with clients locally and abroad more or less all day every day, study and research musculoskeletal pain problems obsessively, and am more or less constantly immersed in answering the question, “What can you do for body parts that hurt?”

And yet I’d never heard of this stuff!

I probably hadn’t heard of it because, although it’s been available in Europe for many years, it was only approved for use in the United States in 2007. Also, topical treatments (salicylates and capsaicin) have shown little potential in the past. Traumeel is even worse: despite enjoying great popularity, there is a lot of evidence that it doesn’t work at all.3

So, a rub-on pain killer that actually works is a pretty new idea!

What is a joint that’s “amenable” to treatment with Voltaren® Gel?

What makes a joint “amenable”? Is it relaxed and agreeable? No, just accessible: an anti-inflammatory gel is useful only for joints that aren’t covered by a thick layer of muscle (like the shoulder). The medication can only get into joints if the joint is just under the surface of the skin.

For those amenable joints, though, Voltaren® Gel delivers medication directly to the joint, while sparing the gastrointestinal tract from the harshness of NSAIDs (many people can’t stomach ibuprofen), and almost eliminating the risks associated with having the stuff spread throughout your tissues.

It’s pretty obvious that there are probably some good uses for Voltaren® Gel above and beyond what it’s already been approved for. Here are some of the conditions I think it might be most useful for:

iliotibial band syndrome
plantar fasciitis
shin splints (particularly medial tibial stress syndrome)
most common tendonitises, especially where the tendon is just under the skin
tennis elbow (lateral epicondylitis)

Achilles tendonitis
patellar tendonitis
carpal tunnel syndrome
ligament sprains

muscle strains
bursitis

Voltaren® Gel is (probably) better than ice!

Ice is good stuff. I have some detailed icing advice on this website.4 But Voltaren® Gel strikes me as being, well, better.

Obviously icing has some advantages. Other than the cost of running your freezer, it’s free. And extremely safe. And “natural,” especially if you use organic, free range ice — uh, from icebergs?

But Vitmain I5 in a gel? C’mon! That’s just awesome! Medication delivered straight to the inflammed tissues, and only the inflammaed tissues … it’s kind of futuristic.

There’s no reason not to use both, of course. But Voltaren® Gel has the potential to make ice nearly obsolete as a treatment choice, except for situations where you don’t have any Voltaren® Gel handy.

On the other hand, there are some risks …

A few words of warning

From the Voltaren® Gel website …

The most common adverse reactions reported in Voltaren Gel clinical trials were application site reactions in 7% of treated patients. With all NSAIDs there may be an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. NSAIDs cause an increased risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal.

Sounds bad, doesn’t it? Don’t be scared. As it says, those are the same risks you’re taking every time you have an Advil. They are real risks, but they are small risks. I think the worst of it is the 7% chance of a “site reaction” (irritated skin).

What about other common pain problems? Could it help low back pain, neck pain, and muscle pain?

A lot of people who read this are going to want to try it on their low back pain, neck pain, and/or other kinds of muscle pain. Will it work? The only honest answer is, “Who knows?” I have no clinical experience with this yet, and certainly it’s unstudied. It might be worth trying, in moderation, with the full awareness that there’s every possibility that it could be a waste of time and money.

Here’s why it probably won’t work …

Low back pain and neck pain usually involve a substantial amount of muscle pain,6 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!

A topical NSAID gel isn’t likely to either.

Also, many painful factors in neck, back and muscle pain are deep inside the body — probably much deeper than Voltaren® Gel can “reach.” For instance, if your low back pain is coming from the facet joints — small joints deep in the spine, under a thick layer of muscle — chances are that a topical treatment simply doesn’t stand a chance of having an effect.

That said, why not try it? It’s almost certainly safer than popping ibuprofen! Although not tested and approved for reckless experimentation on any pain problem, obviously the entire point of Voltaren® Gel is to limit exposure to the active ingredient. So you might choose to experiment — taking full responsibility for your actions, of course, and not suing me if something goes horribly wrong, because of course I’m not actually recommending it, wink. Seriously: just run it by your doctor.

Notes

Altman et al. “Topical therapy for osteoarthritis: clinical and pharmacologic perspectives.” Postgrad Med J. 2009. Full Abstract:

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. In contrast, the guidelines of the American Pain Society and American College of Rheumatology have in the past recommended topical methyl salicylate and topical capsaicin, but not topical NSAIDs. This reflects the fact that the American guidelines were written several years before the first topical NSAID was approved for use in the United States. Neither salicylates nor capsaicin have shown significant efficacy in the treatment of OA. In October 2007, diclofenac sodium 1% gel (Voltaren Gel) became the first topical NSAID for OA therapy approved in the United States following a long history of use internationally. Topical diclofenac sodium 1% gel delivers effective diclofenac concentrations in the affected joint with limited systemic exposure. Clinical trial data suggest that diclofenac sodium 1% gel provides clinically meaningful analgesia in OA patients with a low incidence of systemic AEs. This review discusses the pharmacology, clinical efficacy, and safety profiles of diclofenac sodium 1% gel, salicylates, and capsaicin for the management of hand and knee OA.
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The vast majority of therapies and interventions that sound good actually don’t work. In medicine, “common sense” rarely correlates with reality. Return to text.
For more detail, see another article on SaveYourself.ca, Does Traumeel Work? A detailed review of Traumeel®, a homeopathic remedy (not herbal) widely used for muscular pain, joint pain, sports injuries, bruising, and post-surgical inflammation. Return to text.
For more detail, see another article on SaveYourself.ca, Icing for Injuries and Tendinitis: Become a cryotherapy master. Return to text.
That’s “ibuprofen.” Return to text.
This is one of the most important and useful major ideas presented and explained on this website. For full details and all the evidence, see the neck pain or low back pain tutorials. Return to text.