For patients with chronic pain involving limited areas of the body, they might not have to expose themselves to the toxicities of oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as Motrin and Naproxen.  These toxicities can lead to stomach ulcers, high blood pressure, kidney problems and liver problems, to name a few.

But now it is possible to rub an NSAID on the skin.

The United States Food and Drug Administration recently approved Voltaren Gel as the first prescription skin gel to treat the pain of osteoarthritis.   The main ingredient in this new gel is diclofenac, an NSAID that is the chief ingredient in Voltaren tablets.

Voltaren gel is used to treat joint pain in the hands, wrists, elbows, knees, ankles, and feet caused by osteoarthritis.

Voltaren Gel gives patients the ability to apply a topical medication that can reduce pain, and yet is minimally absorbed systemically.   It appears that Voltaren Gel works as well as Voltaren tablets when it comes to those joints that are closer to the surface of the body, such as the hands, knees, elbows and ankles.

In fact, pain levels fell by 46% among patients with osteoarthritis of the hands after six weeks of regularly applying the Voltaren Gel.   And, in a 12-week study of patients with osteoarthritis of the knee, there was a 51% reduction in pain.

While the risk of absorbing Voltaren Gel into the bloodstream is low, there is still enough of a theoretical risk that patients must be warned, for example, to not use Voltaren Gel just before or after having heart bypass surgery.

In addition, Voltaren Gel can increase the risk of stomach and intestinal bleeding and perforation; and heart attack or stroke.   Older patients are at greater risk for such side effects.

The risk for adverse effects due to Voltaren Gel is quite a bit higher in those patients also taking an oral NSAID.

It is very important for patients to report any pre-existing conditions to their doctors before accepting a prescription for Voltaren Gel.   The most concerning conditions being:

1. History of asthma or severe allergic reaction after taking aspirin or any NSAID.
2. History of stomach ulcer or bleeding.
3. Liver disease.
4. Kidney disease.
5. High blood pressure.
6. Congestive heart failure.

As there might be some confusion as to how much Voltaren Gel should be applied, the medication is supplied with so-called dosing cards that show patients exactly how much gel should be used:   The gel is squeezed onto the card along the line for the particular dose, and then the patient wipes the card directly onto the joint in need of pain relief.   The medication is then gently rubbed into the skin.

This is a medication I feel will be rather useful in the fight against the chronic pain of osteoarthritis.   As you can see, it is not without risk.   And it may be easier for those patients with pain in many joints to simply take a pill.

All things considered, I like the efficacy and safety data for Voltaren Gel. In future entries I will review some of the other prescription topicals.