Topical pain med.

Topical NSAIDs

by AgentX86 - 2022-03-16 00:12:28

Anne, you're not alone.  Since I can't (regularly) use an NSAID either, my hand orthopedic surgeon told me to use a topical.  I'm hesitant because if it can penetrate the skin and get to the joint, what's stopping it from getting into the blood?  My pain is tolerable and mostly just an annoyance so haven't bothered asking my cardiologist. 

Sometimes I have knee or foot pain.  Two ibuprofen will completely fix the problem it so it's not a big deal.  My cardiologist doesn't have a problem with this if taken only on occaision.

The topical NSAID would be long-term so, like you, I question the safety.  If I were going to use it, I'd certainly ask my cardiologist.

TOPICAL NSAID

by TAC - 2022-03-16 01:42:03

I believe that questions about taking or not taking a particular medicine don't belong in this forum. They should be referred to your doctor who knows your medical case and who is licensed to practice medicine. 

NSAIDs cause salt+water retention

by crustyg - 2022-03-16 04:08:00

Hi: It's a good question.  All of the NSAIDs cause a small degree of salt+water retention (due to their interference with prostaglandin mediated distribution of blood flow in the kidneys).  I've seen a patient with fairly severe, but controlled HF tipped into acute HF with ibuprofen.

And, despite what the vendors' marketing would have you believe, all topical NSAIDs produce systemic absorption, and hence systemic effects.

So you are right to be cautious, and I note that you normally use acetaminophen for pain relief.

Ask your PCP.  I suspect that limited use (one joint for a couple of days) won't make any difference, and there's no doubt in my mind that part of the reason for the 'effectiveness' of topical NSAIDs is the gentle rubbing of the affected joint/area which promotes increased blood flow => improves healing and repair.

Topical N.S.A.I.DS and Blood thinners

by IAN MC - 2022-03-16 07:06:19

Anne    I think you  are right to raise the question.

My biggest concern would be taking diclofenac with xarelto.

Because the diclofenac is being used topically, the risk of it causing a gastric bleed is obviously greatly reduced but I understand that up to 20% of topical NSAID gets into the blood stream so there  MUST be a slightly  increased risk of  a bleed..

Years ago I read the interesting statistic that more people die in the UK from  NSAID-induced bleeds than die in  road accidents. That is without adding the anti-coagulant  Xarelto,  to the mix  !

Perhaps I am being over-cautious because of this statistic .......but  I would always avoid taking an NSAID , ( whether it be topical or oral, )  with a blood-thinner like Xarelto.

At the end of the day, the decision is yours, as individual doctors may give different advice depending on how risk-averse they are... and it is only YOUR decision whether to take a painkiller or not .

Ian

I second that additional concern

by crustyg - 2022-03-16 10:11:03

I refused all NSAIDs when I was on apixaban: the reduced platelet stickiness caused by the anti-prostaglandin effect of NSAIDs definitely increases the risk of a bleed.  Platelets clumping together are a very important first line of defence when a tiny blood vessel is damaged. I notice far more oozing from a nick whilst shaving when taking NSAIDs than I saw whilst 'fully' anti-coagulated with apixaban.  But the advantage of all of the NOACs (like apixaban) is that they are very specific in the part of the clotting cascade that they interfere with - unlike warfarin which has a very wide effect on clotting - so it works for mechanical heart valves, but NOACs don't.

The product insert for apixaban warns of an increased risk of bleeding if taken with NSAIDs, but it doesn't say 'avoid at all costs.' Age is also a factor (>75years of age).

My PCP Suggested Diclofenac Gel for Arthritis Pain Too

by Marybird - 2022-03-16 11:57:07

This was in lieu of taking an occasional ( though maybe too often for me, once or twice a week) naproxen sodium tab for athritis pain-when it gets bad enough the acetominophen doesn't help. I'm also taking Eliquis, and while I haven't had problems I can see with it, no overt signs of bleeding or even extra bruising, a recent checkup showed my hemoglobin level had dropped 2 grams- to 9.8. Further testing showed I was seriously iron deficient. 

In addition to an iron supplement, the PCP told me to STAY AWAY from the oral NSAIDS, but suggested  Voltaren gel- the over the counter version.

If you read the package insert, the information on the side of the box, there are specific instructions for taking it, including one not to exceed applying it to more than two sites at any one time, and a card with lines on it showing how much to apply to a given area. It also states the gel can be applied 4× a day. It's also stated that approximately 8% of topical version of the diclofenac is absorbed into the system, as opposed to much higher percentages from oral medication. That's assumed, of course, the manufacturer's instructions are followed. I'm doing my best to follow those instructions, and use thegel only on the areas that hurt the most- around the base of my thumbs and around there, and I use it maybe twice a day. 

Guess time will tell if I can get away with using the gel judiciously, I'm to have the bloodwork repeated in a few weeks ( one month from the last results.)

I'd say that most likely the risk of bleeding from topical NSAIDS is significantly less than for oral NSAIDS, especially if the amount applied over time doesn't exceed the instructions. Though it's probably a good idea to run all this by your healthcare provider, especially if you are looking at long term use, and/ or are taking an anticoagulant.