Myth: “If my joints hurt, I need to take a pill. That’s the only thing strong enough to work.”
Reality: Oral pain medicines are not the only option for localized arthritis pain.
For some people—particularly those with knee or hand osteoarthritis—topical treatments such as topical NSAIDs can provide pain relief while producing lower systemic exposure than comparable oral NSAIDs.
Clinical guidelines strongly recommend topical NSAIDs for knee osteoarthritis and conditionally recommend them for hand osteoarthritis. [ACR/Arthritis Foundation Guideline]
However, topical does not mean risk-free. Some of the medication can still be absorbed into the bloodstream, and the safety profile depends on the active ingredient, formulation, amount used, application area, and the person’s health conditions and other medications. [Topical NSAID Evidence]
If you’re managing arthritis pain and want to reduce your reliance on oral pain medicines, this guide will walk you through the key questions to consider before choosing a topical option.
The Problem With the “Pill First” Habit
Arthritis becomes more common with age. In 2022, diagnosed arthritis affected 53.9% of U.S. adults age 75 and older, according to data from the National Health Interview Survey.
The CDC definition includes several conditions, including osteoarthritis, rheumatoid arthritis, gout, lupus, and fibromyalgia, so the appropriate treatment depends on the type of arthritis and the person’s individual health situation. [CDC, 2022]
Oral NSAIDs such as ibuprofen and naproxen are commonly used to manage pain and inflammation.
However, their risks become particularly important to consider in older adults and people with gastrointestinal, cardiovascular, or kidney problems. [CDC Clinical Practice Guideline]
Because oral NSAIDs are systemically absorbed, they can affect tissues and organ systems beyond the painful joint.
Gastrointestinal bleeding, ulcers, cardiovascular effects, and kidney problems are among the safety concerns associated with systemic NSAID use, particularly in people with relevant risk factors. [CDC Clinical Practice Guideline]
This does not mean every older adult who takes an oral NSAID will develop these complications.
The level of risk depends on factors such as the specific NSAID, dose, duration of use, age, existing health conditions, and other medicines being taken. [CDC Clinical Practice Guideline]
The challenge, then, isn’t simply finding pain relief. It’s finding an approach that fits the location and cause of the pain while taking the person’s overall health and medication risks into account.
Your Decision Tree for Safe Arthritis Pain Relief
Let’s walk through this together. Answer each question honestly, and follow the path that fits your situation.
Do you have osteoarthritis pain in a localized joint such as your knee or hand?
YES → Topical NSAIDs may be an option worth discussing, particularly for knee or hand osteoarthritis.
NO → If your pain comes from a deeper joint such as the hip, is widespread, or may have another cause, move to the section below on other treatment considerations.
Why this matters: Topical medicines need to pass through the skin to reach tissues beneath the application site.
Evidence and clinical guidelines support topical NSAIDs particularly for knee and hand osteoarthritis, while the depth of the hip joint makes topical NSAIDs less likely to provide meaningful benefit. [ACR/Arthritis Foundation Guideline]
Are you currently using an oral NSAID such as ibuprofen or naproxen regularly?
YES → A topical NSAID may be worth discussing with your healthcare professional, particularly if your pain is localized to the knee or hand.
NO → You may still consider a topical option if it is appropriate for the location and type of pain.
The evidence: Clinical guidelines support topical NSAIDs for knee osteoarthritis and, with a conditional recommendation, for hand osteoarthritis.
Compared with oral NSAIDs, topical NSAIDs can provide similar pain relief for some musculoskeletal conditions while producing lower systemic exposure and fewer gastrointestinal adverse events. [ACR/Arthritis Foundation Guideline] [PubMed 23703519]
In a randomized trial of older adults with chronic knee pain, advice to use topical or oral ibuprofen produced equivalent knee-pain outcomes over 12 months, while the oral group experienced more minor adverse effects and more treatment changes because of adverse effects. [TOIB Study]
Do you have a history of stomach ulcers or gastrointestinal bleeding, kidney disease, or heart disease—or are you age 75 or older?
YES → These factors make the choice of pain reliever more important. Talk with your doctor or pharmacist before starting, changing, or combining NSAID treatments. A topical NSAID may be considered for localized osteoarthritis pain in some people, but it is not automatically risk-free.
NO → You may still consider a topical option for localized osteoarthritis pain. Oral pain medicines may also be appropriate in some situations, depending on your symptoms, health conditions, other medications, and the type of arthritis.
Why this matters: Older adults and people with gastrointestinal, cardiovascular, or kidney risk factors require more careful consideration when NSAIDs are used.
Topical NSAIDs generally produce lower systemic exposure than oral NSAIDs, which can reduce some systemic adverse effects, but systemic absorption still occurs and caution may be needed in people with kidney, cardiovascular, or other medical conditions. [pmc.ncbi.nlm.nih.gov]
Evidence from reviews and observational research supports considering topical NSAIDs as an alternative to oral NSAIDs for some older adults with localized osteoarthritis, particularly when gastrointestinal or other systemic risks make oral NSAIDs less desirable.
However, treatment should still be individualized rather than based on age or a single medical condition alone. [PubMed]
What type of topical pain relief are you considering?
Topical pain relievers come in several different categories. The active ingredient matters because these products do not all work in the same way or have the same evidence for arthritis pain.
→ Topical NSAIDs, such as diclofenac gel
These medications reduce inflammation and pain through NSAID activity.
Topical diclofenac has the strongest guideline support among topical options for knee osteoarthritis, with a conditional recommendation for hand osteoarthritis. [ACR/Arthritis Foundation osteoarthritis guideline]
→ Counterirritants, such as menthol or camphor
These ingredients create cooling or warming sensations that can temporarily alter the perception of pain.
They are a different category from topical NSAIDs and should not be presented as having the same anti-inflammatory evidence. FDA’s OTC external analgesic monograph recognizes menthol and camphor as counterirritant active ingredients.
→ Lidocaine
Lidocaine is a local anesthetic that reduces pain sensation by temporarily numbing the treated area.
It may be useful for certain types of localized pain, but its mechanism and evidence are different from those of topical NSAIDs.
→ Salicylate-containing topical products
These are another category of topical analgesics.
Because salicylates are chemically related to aspirin, people taking aspirin or other medications that affect bleeding should check with a healthcare professional before using them regularly.
Which option makes sense?
For localized knee or hand osteoarthritis, topical diclofenac has the clearest evidence and guideline support among these categories.
For someone looking for temporary symptomatic relief without an NSAID, a menthol/camphor counterirritant may be another option. However, the evidence and mechanism are different from topical diclofenac.
The right choice depends on the type and location of pain, other medical conditions, medications, and the product’s active ingredients.
Actionable Tips for Using Topical Pain Relief Safely
1. Apply topical pain relief only to clean, dry skin.
Avoid applying it to cuts, open wounds, infections, rashes, or significantly irritated skin
Always follow the directions on the specific product label, because application instructions can vary between active ingredients and formulations. [DailyMed]
2. Wash your hands after applying the product.
Unless your hands are the treatment area, wash them after application to reduce accidental transfer of the product to your eyes, mouth, or other areas.
If you’re treating your hands, follow the product’s specific instructions for when to wash them. [DailyMed]
3. Avoid heating pads or other external heat unless the product label specifically says otherwise.
For example, OTC diclofenac gel should not be applied with external heat such as a heating pad. [DailyMed]
Follow the product label rather than assuming that heat is safe with every topical pain reliever.
4. Follow the product’s dosing schedule and give it enough time to work.
Different topical pain relievers have different directions for frequency and duration.
For example, OTC diclofenac gel is labeled for regular use four times daily and for use for up to 21 days unless directed otherwise by a doctor. Do not increase the amount or frequency simply because your pain has not improved yet. [DailyMed]
5. Pair pain relief with joint-friendly movement and other arthritis-management strategies.
Topical pain relief can be one part of an overall arthritis-management plan.
Regular physical activity can help reduce arthritis pain and improve physical function, while maintaining a healthy weight may help reduce pain and disability in people with has a higher weight or obesity.
Choose activities that are appropriate for your joints and fitness level, and start gradually if you have been inactive.[cdc.gov]
A Gentle Recommendation
If you’re considering a topical pain reliever for arthritis, start by looking at the active ingredient and the type of pain relief it provides, rather than choosing a product simply because it is marketed as “strong” or “natural.”
For localized knee or hand osteoarthritis, topical diclofenac is an evidence-supported option.
The American College of Rheumatology and Arthritis Foundation strongly recommend topical NSAIDs for knee osteoarthritis and conditionally recommend them for hand osteoarthritis.
Other topical products work differently. Menthol and camphor are used as external analgesic/counterirritant ingredients, while lidocaine is a local anesthetic.
These products can provide symptomatic pain relief, but they should not automatically be considered equivalent to topical NSAIDs for osteoarthritis.
If you’re looking for an OTC menthol/camphor option, Arctic Blast is one product you may consider.
Its current DailyMed label lists menthol 10% and synthetic camphor 3% as the active ingredients and indicates temporary relief of minor aches and pains associated with arthritis, sprains, strains, bruises, and simple backache.
However, Arctic Blast should be viewed as one symptomatic-relief option, not a required treatment or a substitute for medical evaluation.
Its label does not establish that it treats the underlying cause of arthritis, and the product’s botanical ingredients are listed as inactive ingredients rather than active analgesic ingredients.
If you decide to try it, follow the product label carefully.
The current label instructs adults to apply it to the affected area no more than 3–4 times daily, avoid wounds or damaged skin, avoid contact with the eyes, and avoid tight bandaging.
It also says to stop use and ask a doctor if the condition worsens or symptoms persist for more than seven days.
The goal isn’t to find one product that works for everyone.
The better approach is to match the active ingredient and treatment approach to your type of pain, health conditions, other medications, and personal preferences.
Conclusion: Relief Without Trade-Off
Growing older does not mean you have to simply accept arthritis pain or choose a pain reliever without considering its potential risks.
For some people with localized osteoarthritis—particularly knee or hand OA—topical treatments can provide a useful option for pain relief.
Topical NSAIDs such as diclofenac have strong evidence and guideline support for knee osteoarthritis and may provide similar pain relief to oral NSAIDs with lower systemic exposure and fewer gastrointestinal adverse events in many studies. [ACR/Arthritis Foundation Osteoarthritis Guideline] [Topical vs. Oral NSAID Evidence Review]
But topical does not automatically mean risk-free.
The appropriate choice depends on the type and location of arthritis, your age, medical conditions, other medications, and the active ingredient in the product.
For people who prefer an OTC non-NSAID topical option, products containing ingredients such as menthol or camphor may provide temporary symptomatic relief.
These products work differently from topical NSAIDs and should not be assumed to have the same evidence for treating osteoarthritis. [FDA OTC External Analgesic Monograph]
The goal is not to find one pain-relief product that is right for everyone.
Instead, choose an approach that matches your pain, health situation, and treatment goals—and talk with a healthcare professional when you’re unsure, particularly if you are older, take multiple medications, or have kidney, heart, or gastrointestinal conditions.
Relief should be about more than reducing pain. It should also involve making a thoughtful choice about how that relief fits into your overall health.
Considering a Topical Pain Relief Option?
If you’re looking for localized arthritis pain relief, a topical product may be one option to discuss with your doctor or pharmacist.
Depending on your type of pain and health situation, options may include topical diclofenac, menthol/camphor products, or other topical analgesics.
If you’re interested in an OTC menthol/camphor option, Arctic Blast is one product you can consider. Check the active ingredients and product directions before use, especially if you take other medications or have ongoing health conditions.
This is an optional product recommendation, not a requirement. Always follow the product label and consult a healthcare professional when appropriate.
Frequently Asked Questions
Is topical pain relief safe if I’m taking blood pressure medication?
It depends on the active ingredient and your medications. Topical NSAIDs such as diclofenac generally produce lower systemic exposure than oral NSAIDs, but they can still be absorbed into the bloodstream and may interact with certain medicines.
For example, the prescribing information for topical diclofenac warns that it may reduce the blood-pressure-lowering effect of ACE inhibitors, ARBs, and beta-blockers.
It also advises monitoring for kidney problems in certain older adults or people with impaired kidney function, particularly when ACE inhibitors or ARBs are used at the same time. [DailyMed]
If you take medication for high blood pressure, kidney disease, heart disease, or other chronic conditions, check with your doctor or pharmacist before regularly using a topical NSAID.
Important: This caution is specifically relevant to topical NSAIDs such as diclofenac. Other topical pain relievers, such as menthol/camphor products, have different active ingredients and should be evaluated according to their own labels.
How long can I use topical pain relief?
The appropriate duration depends on the active ingredient and the specific product.
For example, OTC diclofenac sodium topical gel is labeled for use up to 21 days unless directed by a doctor.
It should be used according to the labeled dosing schedule rather than applied more frequently when pain continues. [DailyMed]
Other topical analgesics, including menthol- or camphor-based products, have their own directions and maximum recommended frequency.
Follow the product label rather than assuming that all topical pain relievers can be used for the same length of time.
If your pain is getting worse, does not improve as expected, or keeps returning, talk with a healthcare professional rather than simply continuing or increasing the topical treatment.
Ready to Explore Your Options?
Arthritis pain relief doesn’t have to be a one-size-fits-all decision.
If you’re considering a topical treatment, talk with your doctor or pharmacist about which option fits your pain location, arthritis type, medical history, and current medications.
For people looking for an OTC menthol/camphor product, Arctic Blast is one option to consider for temporary relief of minor aches and pains associated with arthritis.
Its labeled active ingredients are menthol 10% and synthetic camphor 3%. [DailyMed]
Use any topical pain reliever according to its product label. If your pain worsens, persists, or you’re unsure whether a topical product is appropriate for you, speak with a healthcare professional.
Affiliate disclosure: This link may be an affiliate link, which means we may earn a commission if you make a purchase, at no additional cost to you.
Where Do You Go From Here?
Finding the right approach to arthritis pain is not always about choosing a stronger pain reliever. Sometimes, the next step is understanding what your joints need—and whether the pain is coming from a problem that topical relief can realistically address.
If you’re interested in learning more, these guides can help you explore the next part of the journey:
Start with topical relief:
How Topical Pain Relief May Support Joint Mobility
Learn how topical pain relief fits into a broader approach to staying comfortable and maintaining everyday movement.
Looking for an OTC option for everyday stiffness?
Explore OTC Pain Relief Options for Daily Joint Stiffness
Explore different topical approaches and what to consider when choosing an OTC product for recurring joint discomfort.
What if the pain feels deeper?
How to Relieve Deep Joint Pain: What Options May Help?
When pain seems to come from deeper inside a joint, topical treatments may not always be the most appropriate approach. Learn about other considerations for deeper joint pain.
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