If you’re in pain, anti-inflammatory tablets may be beneficial, however rising concerns over side effects are causing people to consider anti-inflammatory gels and creams as an alternative. Are they actually effective and if so, which one is best?

This blog follows on from last week’s article comparing heat packs vs deep heat creams.

Anti-inflammatory Options

When it comes to anti-inflammatory medication, there are various options ranging in effectiveness and side effects.

The most powerful anti-inflammatory effect can be gained by a corticosteroid injection (cortisone). This is like a water bomber dropping water on a fire. There are some risks such as infection, flare of pain, possible short term weakening of tissue and anxiety.

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The next most effective option is oral anti-inflammatory medications such as prednisolone (steroid – prescription only) and Non Steroidal Anti Inflammatories (NSAIDs), which are available over the counter (Nurofen, Voltaren, etc) or via prescription (Naprosyn, Celebrex, Mobic, etc). This is like using a garden hose to squirt water on a fire but it goes everywhere (systemic). Short-term side effects are rare but can affect the gastro-intestinal tract, kidneys, blood pressure, those with asthma, etc. It is advisable to consult a GP or pharmacist before commencing NSAIDs.

Finally, the topic of this blog involves the use of anti-inflammatory gels and creams, which include steroid based (not covered) and non steroid based such as voltaren and nurofen gel. These are like throwing a bucket of water at a targeted section of the fire. Less of the drug is absorbed into the blood stream when compared to oral medication, therefore the risk of harmful side effects is significantly lower.

Do Anti-inflammatory Gels and Creams Actually Work

The short answer is yes! A recent review of the literature (research evidence) by Cochrane revealed that topical NSAIDs provided good levels of pain relief in acute conditions such as sprains, strains and overuse injuries, probably similar to that provided by oral NSAIDs.

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But if it’s like using a bucket of water compared to a hose, how can we maximize the effectiveness? For a topical NSAID to be effective, it has to reach the inflamed tissue in sufficient concentration to produce a relevant anti-inflammatory effect.

Factors Influencing the Effectiveness of Anti-inflammatory Gels and Creams

• Concentration – The concentration of anti-inflammatory medication in the gel/cream obviously has a strong bearing on how much is absorbed by the tissues. Voltaren has recently released their voltaren gel osteo 12 hourly product, which has twice the concentration of diclofenec (medication) compared to their standard product.
• Formula – The formulation is crucial for skin penetration. Without getting into too much detail, gel is more effective than cream.
• Blood Flow – If blood flow to the area is increased due to exercise, a heat pack, a hot shower, massage, etc there is a better chance of the medication being absorbed.
• Wraps – Sports Doctors often recommend wrapping the affected area in glad wrap after applying the anti inflammatory gel to increase the time the gel has to penetrate the skin before being rubbed off or evaporating.
• Massage – Don’t forget about the beneficial effects of massage including pain relief and increased blood flow. Some believe that the beneficial effects of anti-inflammatory creams can be attributed in full to the massage and not the actual cream/gel. However research has proven that anti-inflammatory gels and creams provide significantly more pain relief than placebo gels and creams when massaged into the affected area.

What Conditions do Anti Inflammatory Gels and Creams Help?

As discussed, the anti-inflammatory gel has to penetrate the skin before it can reach the affected tissues, so the problem area mustn’t lie too far away from the skin surface. Therefore anti-inflammatory gels are more likely to assist the following conditions:

• plantar fasciitis
• patellar tendinitis
• Achilles tendinitis
• ITB syndrome
• shin splints
• tennis and golfer’s elbow
• ligament strains
• bursitis
• acute muscle strains

Although pain from the neck and back often comes from deep structures it doesn’t hurt to try anti-inflammatory gels.

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Summary

• Anti-inflammatory gels are likely to provide pain relief for conditions that are close to the surface of the skin.
• Voltaren Osteo 12 Hourly Gel is likely to be the most effective due to it’s high concentration of anti-inflammatory agent.
• Massage the gel in if comfortable and consider wrapping the area in glad wrap over night.

Considerations

• Don’t apply topical creams or gels to broken skin.
• If you have eczema or other hand problems, wear a latex glove when applying gel.
• Allergic reactions are uncommon, but on first use only apply a small amount to a clean, healthy area of skin and gently rub in until absorbed. Wait a while to test how you respond to the ingredients before using more. If skin redness, irritation or itching occurs, wash off and seek medical advice.
• Wash your hands immediately after applying the treatment.
• Don’t touch or rub your eyes while you have topical cream on your hands.
• Follow the directions on the package.
• Do not use any topical treatments if you are pregnant or breastfeeding, without seeking advice from a pharmacist or doctor.