What is the proper use of Voltaren (diclofenac) cream for pain or inflammation?

Proper Use of Voltaren (Diclofenac) Cream for Pain and Inflammation

Topical diclofenac is strongly recommended as first-line therapy for knee osteoarthritis pain due to its superior efficacy compared to placebo and equivalent effectiveness to oral diclofenac, while causing significantly fewer gastrointestinal adverse events. 1

Application Instructions

• Apply diclofenac topical solution to clean, dry skin 2
• For osteoarthritis knee pain, apply 2 pump actuations (40 mg) directly onto each painful knee, twice daily 2
• Spread evenly around front, back, and sides of the affected area 2
• Wash hands thoroughly after application to avoid accidental contact with eyes, nose, or mouth 2
• Wait until the treated area is completely dry (at least 30 minutes) before:
  • Covering with clothing 2
  • Applying sunscreen, insect repellent, cosmetics, or other topical medications 2
  • Allowing skin-to-skin contact with other people 2

Efficacy and Mechanism

• Diclofenac is the only commercially manufactured topical NSAID currently available in the United States 1
• Topical diclofenac has been shown to:
  • Preferentially distribute to target tissues in therapeutic concentrations 3
  • Provide pain relief comparable to oral NSAIDs (diclofenac, ibuprofen, naproxen) 3
  • Improve functional capacity and mobility in affected joints 3
• Systematic reviews have demonstrated topical diclofenac is superior to placebo for knee osteoarthritis pain 1

Safety Profile

• Topical diclofenac has markedly fewer gastrointestinal adverse events compared to oral NSAIDs 1
• Most common side effects are mild, localized skin reactions that resolve easily 3
• Safety profile remains consistent even with extended use up to 1 year 1
• Avoid combination therapy with oral NSAIDs unless benefits outweigh risks 2

Clinical Considerations

• Topical diclofenac is particularly beneficial for:
  • Knee osteoarthritis pain (strong evidence) 1
  • Older adults who may be more susceptible to systemic NSAID side effects 4
• Not recommended for hip osteoarthritis due to the depth of the joint and limited evidence of benefit 1
• For actinic keratosis, diclofenac 3% in 2.5% hyaluronic gel is applied twice daily for 60-90 days (different formulation than for pain) 1

Common Pitfalls and Caveats

• Do not apply to open wounds 2
• Avoid external heat or occlusive dressings on treated areas 2
• Avoid showering/bathing for at least 30 minutes after application 2
• Protect treated areas from natural and artificial sunlight 2
• Topical diclofenac is not recommended as an adjunct to cryosurgery for actinic keratosis (different indication) 1

Comparison to Other Pain Treatments

• Topical capsaicin (0.025% to 0.075%) is an alternative for knee osteoarthritis pain but may require 2-4 weeks of continuous use before therapeutic effect 1
• Paracetamol (acetaminophen) is equally effective as oral NSAIDs for osteoarthritis pain with fewer side effects 1
• For ankle sprains, diclofenac showed superior results at days 1 and 2 compared with piroxicam and ibuprofen for reducing pain during motion 1

In conclusion, topical diclofenac provides effective pain relief with a favorable safety profile compared to oral NSAIDs, making it an excellent first-line option for treating localized pain, particularly knee osteoarthritis.