Topical Treatments for Joint Pain: Creams, Gels, and Patches That Work

Key Takeaways

• Topical treatments work directly at the pain site without affecting your whole body
• Voltaren (diclofenac) gel is the most proven option with prescription-strength results
• Capsaicin and menthol creams offer natural pain relief through different mechanisms
• Topical options are safer than oral pain pills for long-term use
• Best results come from proper application and realistic expectations

When joint pain hits, reaching for a cream or gel feels natural. But with dozens of options lining pharmacy shelves, how do you know what actually works?

The good news: several topical treatments have solid research backing them up. The better news: they’re often safer than taking pills every day, especially if you have stomach issues or take multiple medications.

Let’s break down which topical treatments deliver real relief and which ones are mostly marketing.

How Topical Treatments Work

Unlike oral medications that travel through your bloodstream to reach painful joints, topical treatments work locally. You apply them directly to the skin over the painful area.

The advantages are significant:

Most of the medication stays where you need it. Only small amounts enter your bloodstream. This means fewer side effects like stomach upset, drowsiness, or interactions with other medications.

For people over 65, this safety profile matters. When you’re already taking medications for blood pressure, diabetes, or heart health, adding another pill to the mix increases risks. Topical treatments offer a gentler approach.

But here’s what’s important to understand: topical treatments work best for joints close to the skin surface. Think knees, hands, elbows, and ankles. They’re less effective for deeper joints like hips or the spine, simply because the medication can’t penetrate deep enough.

Voltaren Gel: The Gold Standard

If research had to crown a champion, Voltaren (diclofenac) gel would take the prize.

What it is: Diclofenac is an NSAID (non-steroidal anti-inflammatory drug) similar to ibuprofen or naproxen. But instead of swallowing a pill, you rub the gel directly on your painful joint.

The evidence: Multiple studies show Voltaren gel reduces arthritis pain as effectively as oral NSAIDs for knee and hand osteoarthritis. A 2016 study published in Osteoarthritis and Cartilage found that people using diclofenac gel four times daily experienced significant pain relief after 12 weeks.

How to use it properly:

Apply a thin layer to the painful joint 4 times daily. Use the dosing card included in the package to measure the right amount. Rub it in until the gel disappears. Wash your hands after applying (unless you’re treating your hands). Wait at least 10 minutes before covering the area with clothing.

The catch: While Voltaren gel is now available over-the-counter, it’s not cheap. A tube can run $15-25 depending on size. Some insurance plans cover the prescription-strength version with a copay.

Safety note: Even though it’s topical, diclofenac is still an NSAID. If you have heart disease, kidney problems, or stomach ulcers, check with your doctor first. Don’t use it with oral NSAIDs unless your doctor approves.

Capsaicin Cream: The Pepper Extract That Blocks Pain

This one sounds unusual: rubbing pepper extract on your painful joint. But capsaicin—the compound that makes chili peppers hot—has legitimate pain-relieving properties.

How it works: Capsaicin depletes substance P, a chemical your nerves use to send pain signals to your brain. With less substance P available, pain signals decrease over time.

The evidence: Research supports capsaicin for arthritis pain, particularly in knees and hands. A 2014 analysis in The Cochrane Database found high-concentration capsaicin (0.075%) provided moderate pain relief for osteoarthritis.

What to expect: Here’s the tricky part—capsaicin often causes burning or stinging when you first start using it. This usually lessens after a few days of consistent use. The pain relief builds gradually, not immediately.

How to use it:

Apply a thin layer 3-4 times daily. Wear disposable gloves or wash your hands thoroughly after application. Avoid touching your eyes, nose, or sensitive areas for several hours. Be patient—it may take 1-2 weeks to feel the full benefit.

Best for: People who prefer natural options and can tolerate the initial burning sensation. It works well as an add-on to other treatments.

Menthol and Camphor Products: Temporary Relief

Walk down the pain relief aisle and you’ll see dozens of creams with menthol, camphor, or methyl salicylate. Think Bengay, Icy Hot, or Biofreeze.

How they work: These products create a cooling or warming sensation that temporarily distracts from pain. They’re called counterirritants because they irritate the skin just enough to shift your attention away from deeper joint pain.

The truth about effectiveness: While these products provide immediate soothing sensations, they don’t reduce inflammation or address the underlying problem. The relief is temporary—usually lasting 15-30 minutes.

When they’re useful:

Quick relief before physical activity or exercise. Temporary comfort after a long day on your feet. As part of a massage routine to relax tight muscles around painful joints.

They’re inexpensive and widely available, which makes them worth trying. Just keep expectations realistic—they mask pain rather than treat it.

Lidocaine Patches and Creams: Numbing the Pain

Lidocaine is a local anesthetic that temporarily numbs the skin and underlying tissues.

Available options:

Over-the-counter lidocaine patches (up to 4% strength). Prescription-strength patches (5% lidocaine, brand name Lidoderm). Lidocaine creams and roll-ons in various strengths.

How to use patches: Apply to clean, dry skin over the painful area for up to 12 hours, then remove for at least 12 hours. Don’t cut patches to make them fit better—this can cause uneven medication delivery.

Best for: Sharp, localized pain rather than deep, aching joint pain. They work well for nerve-related pain near joints or pain from arthritis in hands and knees.

Advantages: Minimal side effects and very little medication enters the bloodstream. They’re particularly good for people who can’t tolerate other pain medications.

Compounded Creams: Custom Combinations

Some doctors prescribe custom-made topical creams from compounding pharmacies. These might combine multiple medications like ketoprofen (an NSAID), gabapentin (a nerve pain medication), and lidocaine in one cream.

The promise: Combining medications might provide better relief than single-ingredient products.

The reality: Research on compounded creams is limited. They’re expensive (often $100-300 per tube), and insurance rarely covers them since they’re not FDA-approved combinations.

If your doctor suggests a compounded cream, ask about the evidence supporting that specific combination. Sometimes they’re worth trying, but don’t expect miracle results.

Application Tips for Best Results

Getting the most from topical treatments requires proper technique:

Clean and dry the area first. Moisture, lotion, or sweat can block absorption.

Use the right amount. More isn’t better—it just wastes product and increases side effects. Follow package directions for dosing.

Rub it in thoroughly. Don’t just smear it on the surface. Use gentle circular motions until the product absorbs.

Be consistent. Topical treatments work best with regular use, not just when pain flares up.

Give it time. Most topical treatments need 1-2 weeks of consistent use to show full benefits.

Don’t cover with tight bandages. This can increase absorption and potentially cause side effects. Loose clothing is fine.

Safety Advantages Over Oral Medications

For many people, especially those over 65, topical treatments offer important safety benefits:

Gentler on your stomach. Oral NSAIDs can cause ulcers and bleeding, particularly with long-term use. Topical versions have much lower risk.

Fewer drug interactions. Because less medication enters your bloodstream, there’s less chance of interacting with your other prescriptions.

Lower cardiovascular risk. High-dose oral NSAIDs can increase blood pressure and heart problems. Topical NSAIDs carry lower risk.

Easier on kidneys. For people with mild kidney disease, topical treatments put less strain on kidney function.

No sedation or dizziness. Unlike some oral pain medications, topicals won’t affect your balance or mental clarity.

This doesn’t mean topicals are completely risk-free. Always tell your doctor about everything you’re using, including over-the-counter topical treatments.

When Topicals Aren’t Enough

Topical treatments shine for mild to moderate arthritis pain in accessible joints. But they have limitations.

Signs you need more than topical treatment:

Pain interferes with daily activities despite consistent topical use. You’re using topicals constantly just to function. Pain wakes you up at night. Your joint feels unstable or gives out unexpectedly. You’ve developed significant stiffness or reduced range of motion.

When topical treatments stop working well enough, it’s time to discuss other options with your doctor.

The treatment ladder approach:

Many doctors recommend starting with topical treatments and lifestyle changes (exercise, weight management) as first-line options. If these don’t provide adequate relief, the next steps might include oral medications, physical therapy, or injection therapies.

Hyaluronic acid injections, for example, can provide longer-lasting relief for knee osteoarthritis when creams and gels aren’t cutting it anymore. These injections help restore cushioning in the joint and may reduce pain for several months.

The key is having a plan that escalates treatment based on your response, not suffering unnecessarily because you’re trying to avoid “stronger” options.

Choosing the Right Topical Treatment for You

With so many options, where should you start?

For moderate arthritis pain in knees or hands: Voltaren gel is your best evidence-based choice. Give it a full 2-week trial with proper application.

For mild, occasional pain: Menthol or camphor products like Biofreeze offer quick, temporary relief at low cost.

If you prefer natural options: Capsaicin cream is worth trying if you can tolerate the initial burning sensation.

For localized, sharp pain: Lidocaine patches might work better than creams.

If cost is a concern: Generic menthol products and store-brand versions of popular creams can save money. Ask your pharmacist about generic diclofenac gel.

Remember that everyone responds differently. What works wonderfully for your neighbor might not help you much. Be willing to try 2-3 options (one at a time, giving each a fair trial) before deciding topicals don’t work for you.

The Bottom Line

Topical treatments offer real benefits for joint pain, especially when you want to avoid or reduce oral medications. They’re safer for long-term use and work well for accessible joints like knees, hands, and elbows.

Voltaren gel stands out as the most proven option, with evidence matching oral NSAIDs for effectiveness. Capsaicin provides a natural alternative for those willing to tolerate initial discomfort. Menthol and lidocaine products fill specific needs for temporary relief.

But be realistic about what topicals can and can’t do. They work best for mild to moderate pain in surface joints. For deeper joints, severe arthritis, or pain that significantly limits your life, you’ll likely need additional treatments.

The goal isn’t to tough it out with creams alone when better options exist. Use topical treatments as part of a comprehensive approach to managing your joint pain—alongside exercise, weight management when appropriate, and other therapies as needed.

Frequently Asked Questions

Can I use multiple topical treatments at the same time?

Don’t layer different topical products on the same joint without asking your doctor. Combining topicals can increase side effects or reduce effectiveness. If one product isn’t working, finish the trial period (usually 2 weeks) before switching to another option.

Will topical treatments cure my arthritis?

No. Topical treatments manage pain and may reduce inflammation, but they don’t reverse arthritis or repair damaged cartilage. Think of them as tools for improving comfort and function, not cures.

Are expensive prescription compounded creams better than OTC options?

Not necessarily. Many compounded creams lack strong research supporting their specific combinations. Start with proven options like OTC Voltaren gel before spending hundreds on compounded products.

How long can I safely use topical treatments?

For most OTC topicals, you can use them long-term as needed. However, check with your doctor if you’re using them daily for more than a few months. They’ll want to monitor your condition and make sure you’re getting appropriate care.

Why isn’t my topical treatment working?

Common reasons include not using enough product, inconsistent application, applying to wet or dirty skin, or having arthritis too severe for topical treatment alone. Make sure you’re following directions exactly for at least 2 weeks before judging effectiveness.

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This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare provider before starting any new treatment. Last reviewed: February 2025