Pain & inflammation
Topical NSAIDs
Anti-inflammatory gels and creams — Rub-on anti-inflammatory gels for localised joint and muscle pain — effective with far less whole-body risk.
Education and reference only. This is a plain-language class overview — it deliberately contains no doses. Always check the current Summary of Product Characteristics (SmPC), the BNF and your local formulary before prescribing or administering any medicine.
Quick answer
What is Topical NSAIDs?
Topical NSAIDs are anti-inflammatory painkillers applied directly to the skin over a painful joint or muscle. They relieve localised pain and inflammation with much less drug reaching the rest of the body than tablets.
- How it works: They block the enzymes (cyclo-oxygenase) that make the prostaglandins driving local pain and inflammation, just as oral NSAIDs do — but applied to the skin they build up mainly in the tissues underneath, so the painful area is treated while blood levels stay low and whole-body side effects are largely avoided.
- In practice: In practice topical NSAIDs (gels, creams and sprays such as ibuprofen and diclofenac) are a first-line choice for localised musculoskeletal pain — hand and knee osteoarthritis, strains, sprains and other soft-tissue injuries — and are recommended ahead of oral anti-inflammatories for these, especially in older people, because they deliver the drug where it is needed with much lower blood levels and far fewer stomach, kidney and cardiovascular risks.
What it is
Topical NSAIDs are anti-inflammatory painkillers applied directly to the skin over a painful joint or muscle. They relieve localised pain and inflammation with much less drug reaching the rest of the body than tablets.
How it works
They block the enzymes (cyclo-oxygenase) that make the prostaglandins driving local pain and inflammation, just as oral NSAIDs do — but applied to the skin they build up mainly in the tissues underneath, so the painful area is treated while blood levels stay low and whole-body side effects are largely avoided.
In practice
In practice topical NSAIDs (gels, creams and sprays such as ibuprofen and diclofenac) are a first-line choice for localised musculoskeletal pain — hand and knee osteoarthritis, strains, sprains and other soft-tissue injuries — and are recommended ahead of oral anti-inflammatories for these, especially in older people, because they deliver the drug where it is needed with much lower blood levels and far fewer stomach, kidney and cardiovascular risks. The practical points are applying the right amount to the affected area and rubbing it in, washing hands afterwards (and not applying to broken skin, eyes or mucous membranes), and being aware they can cause local skin reactions and a photosensitivity rash, so sun exposure of treated skin is limited. Because a small amount is still absorbed, the usual NSAID cautions are reduced but not entirely gone — significant caution remains in severe kidney disease, and care if someone is already taking oral NSAIDs or is at high bleeding risk. They suit a defined painful area rather than widespread pain, and are a good way to limit how much oral anti-inflammatory a person needs.
Examples
Practical use
How to take it & use it well
- Apply the gel or cream only to clean, unbroken skin over the painful joint or muscle, and rub it in gently as directed rather than using more in the hope of faster relief.
- Wash your hands thoroughly after applying, unless you are treating your hands, and take care to keep it well away from your eyes, mouth and any broken or infected skin.
- Let the area dry and avoid covering it with a tight dressing unless told to, and do not apply heat pads over it, as this can increase how much is absorbed.
- Protect the treated skin from strong sunlight and sunbeds, as some of these gels can make that area more likely to burn or react.
- If you also take anti-inflammatory tablets, tell your pharmacist, as using both together adds to the small amount absorbed and the risk to the stomach and kidneys.
- If your skin becomes very red, itchy or blistered where you apply it, stop using it and seek advice, as this may be a reaction to the product.
Common uses
- Hand and knee osteoarthritis
- Sprains, strains and soft-tissue injuries
- Localised musculoskeletal pain (first-line over tablets)
Monitoring
- Pain relief and the painful area treated
- Local skin reactions or photosensitivity
- Total NSAID exposure if also taking tablets
Weighing it up
Advantages & disadvantages
Advantages
- They ease pain and inflammation in joints and muscles applied right where it hurts.
- Because they act locally, far less is absorbed than with tablets, so the risk to the stomach and kidneys is much lower.
- They are useful for localised problems such as a strained muscle, sprain or arthritis in a single joint.
- Many are available without prescription for short-term aches and strains.
- They can be a gentler option for people who cannot tolerate anti-inflammatory tablets well.
Disadvantages
- They suit localised pain rather than widespread aches, where a different approach may be needed.
- Some of the medicine is still absorbed, so they are used with caution in severe kidney disease or alongside the tablet form.
- They can irritate the skin, causing redness, itching or a rash where applied.
- Some can make the treated skin more sensitive to sunlight.
- They must not be used on broken, infected or rashy skin, which limits where they can go.
Key safety principles
What to watch for
- Apply to the affected area on intact skin only — avoid eyes, mouth and broken skin, and wash hands afterwards.
- Can cause local skin reactions and sun-sensitivity rashes — limit sun exposure of treated skin.
- Much safer than oral NSAIDs but some is absorbed — caution remains in severe kidney disease and with concurrent oral NSAIDs/high bleeding risk.
Key interactions
What to avoid or check alongside
- Using them at the same time as anti-inflammatory tablets adds the small absorbed amount to the tablet, increasing strain on the stomach and kidneys.
- If you take blood-thinning medicines, mention it to your pharmacist, as anti-inflammatories can add a small extra bleeding risk even applied to the skin.
- Applying other creams or cosmetics to the same patch of skin at the same time can reduce contact and effect.
- Strong sunlight and sunbeds on the treated area can trigger burning or a skin reaction with some products.
- People with significant kidney, heart or stomach problems should check with a pharmacist before using these, even though absorption is low.
Patient & carer advice
- Rub it into the sore area and wash your hands afterwards
- Keep treated skin out of strong sun, as it can react
- It is generally much gentler on the stomach and kidneys than anti-inflammatory tablets
Answers
Topical NSAIDs: frequently asked questions
Are anti-inflammatory gels safer than the tablets?
For many people, yes. Because they are applied to the skin, far less reaches the rest of the body than with tablets, so the risk to the stomach and kidneys is much lower. They suit localised pain, but some is still absorbed, so people with severe kidney disease or who also take the tablets should check first.
Can I use the gel and take anti-inflammatory tablets at the same time?
It is best not to without advice. Using both adds the absorbed gel to the tablet, increasing the strain on your stomach and kidneys. Tell your pharmacist what you are taking so they can keep the total safe.
Where should I not put anti-inflammatory gel?
Keep it off broken, infected, rashy or sunburnt skin, and away from your eyes, mouth and other delicate areas. Apply it only to intact skin over the painful spot, and wash your hands afterwards unless you are treating them.
Why does the area sometimes go red or itchy?
Mild redness or itching where you apply it is fairly common as a skin reaction. Some gels also make that skin more sensitive to sunlight. If the area becomes very red, blistered or swollen, stop using it and seek advice.
Can I cover the area with a plaster or use a heat pad?
Avoid tight dressings and heat pads over the treated skin unless your prescriber tells you otherwise, as both can increase how much is absorbed. Let the gel dry and leave the area open to the air where you can.
Authoritative sources
Always verify against the source
This overview is for orientation. For doses, interactions, contra-indications and the full monograph, use:
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