Painkilling gels and creams as good as pills for knee pain
Publication Date:24/06/2008
Many people choose to use painkilling gels or creams for joint pain, instead of tablets. But are they as good? We look at the latest evidence to find out.
What do we know already?
Many people take painkilling medicines called nonsteroidal anti-inflammatory drugs (NSAIDs for short) for joint pain caused by arthritis. Commonly used NSAIDs include ibuprofen and diclofenac. You can get them as tablets or as gels to rub directly into the affected joint. Some NSAIDs also come as creams and sprays.
Ibuprofen is available from pharmacists (as tablets and gels) without a prescription. But other types of NSAIDs and some doses of ibuprofen tablets need a doctor's prescription.
Previous research shows that NSAID tablets work for joint pain, at least in the short term. But the research on gels is less good. Most doctors recommend NSAID tablets, because they believe they work better. But there's not much long-term research.
However, there are problems with NSAID tablets, especially if you have to take them at a high dose, take them regularly and if you are elderly. They can cause side effects, including indigestion and upset stomach. More rarely, they can cause bleeding in the stomach. Taken regularly at very high doses, some may also increase the risk of having a heart attack or stroke in some people. These problems are less likely if you use gels or creams, because a smaller amount of the drug is needed.
So doctors wanted to see if gels could work as well as tablets for people who had long-term knee pain.
What does the new study say?
The study found that gels you rub directly on the knee worked as well as tablets for people with long-term knee pain. The study lasted for two years. At the start, GPs recommended either ibuprofen tablets or ibuprofen gels. GPs either suggested people bought them over the counter or prescribed them.
People in the study were asked periodically about their pain, stiffness in their joints and difficulty in getting on with their lives. The study showed that whichever type of ibuprofen people were using, the results were about the same. The amount of pain they were getting stayed about the same throughout the study.
The study also looked to see if people using gels had fewer side-effects than people using tablets. They found it made little difference. The researchers say this may be because the numbers in the trial may have been too small to show up a difference. Also, the study didn't include anyone who doctors thought might be at risk of serious side effects. This means that people who were most likely to get side effects from ibuprofen tablets were not included.
Where does the study come from?
The study was carried out by researchers at Queen Mary University of London. It was published as a Health Technology Assessment for the National Institute of Health Research, which is part of the Department of Health.
How reliable are the findings?
The study was carefully carried out. But the results are likely to be affected by the opinions of the patients taking the treatments. That's because the patient knows which type of treatment he or she is taking (a pill or a gel). In the best type of study, patients don't know which type of treatment they are taking. In this study, if the patient expected more pain relief from the tablet, it's likely they would be less satisfied with the gel. And if they were expecting more side effects from the tablet, it's likely they would report more side effects from the tablet.
What does this mean for me?
The study shows that you're likely to get the same amount of pain relief, whether you take ibuprofen as a gel or a tablet. So it probably makes sense to take whichever type you prefer, once you've considered the chance of getting side effects.
It's important to check with your doctor or pharmacist to make sure you know about your risk of side effects, especially if you are taking NSAIDs at a high dose or for a long time.
What should I do now?
If you have joint pain, talk to your doctor or pharmacist about the treatments available. You need to weigh up the benefits and risks to find the treatment that works best for you.
From:
Underwood M, Ashby D, Carnes D, et al. Topical or oral ibuprofen for chronic knee pain in older people. The TOIB study. Health Technology Assessment. 2008; 12: 22.
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This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.
