From the Guidelines
The most effective NSAID patch for managing osteoarthritis pain is diclofenac, which has been shown to be superior to placebo and equivalent to oral diclofenac in reducing pain associated with OA of the knee. According to a systematic review by Derry et al, as reported in the 2021 Mayo Clinic Proceedings study 1, topical diclofenac is the only commercially manufactured topical NSAID currently available in the United States and comes in various formulations. The study found that treatment with topical NSAIDs was associated with markedly fewer gastrointestinal adverse events but had substantially more local adverse events than with oral NSAIDs.
Some key points to consider when using NSAID patches include:
- They provide targeted pain relief with potentially fewer systemic side effects compared to oral NSAIDs
- They are particularly useful for patients who cannot tolerate oral NSAIDs due to gastrointestinal issues
- They may cause local skin irritation in some users
- Patients should avoid applying them to broken or damaged skin
- The patches typically need to be applied to clean, dry skin over the affected area and replaced every 12-24 hours depending on the specific product
The safety data for topical diclofenac are largely limited to 12-week follow-up, but two open-label studies found the safety profile at 1 year to be consistent with results at 12 weeks, supporting a "strong for" recommendation in patients with knee OA pain 1. Overall, diclofenac patches are a valuable option for managing OA pain in the knee, with a favorable safety profile and effective pain relief.
From the FDA Drug Label
NSAID medicines that need a prescription Generic Name Tradename Celecoxib Celebrex Diclofenac Cataflam, Voltaren, Arthrotec (combined with misoprostol) Diflunisal Dolobid Etodolac Lodine, Lodine XL Fenoprofen Nalfon, Nalfon 200 Flurbiprofen Ansaid Ibuprofen Motrin, Tab-Profen, Vicoprofen* (combined with hydrocodone), Combunox (combined with oxycodone) Indomethacin Indocin, Indocin SR, Indo-Lemmon, Indomethagan Ketoprofen Oruvail Ketorolac Toradol Mefenamic Acid Ponstel Meloxicam Mobic Nabumetone Relafen Naproxen Naprosyn, Anaprox, Anaprox DS, EC-Naprosyn, Naprelan, Naprapac (copackaged with lansoprazole) Oxaprozin Daypro Piroxicam Feldene Sulindac Clinoril Tolmetin Tolectin, Tolectin DS, Tolectin 600
The names of some NSAIDs patches are not explicitly mentioned, however, some NSAIDs are listed, including:
- Diclofenac (also known as Voltaren), which is available as a patch, although the patch formulation is not mentioned in this label. Other NSAIDs mentioned include:
- Celecoxib (Celebrex)
- Diflunisal (Dolobid)
- Etodolac (Lodine, Lodine XL)
- Fenoprofen (Nalfon, Nalfon 200)
- Flurbiprofen (Ansaid)
- Ibuprofen (Motrin, Tab-Profen, Vicoprofen*, Combunox)
- Indomethacin (Indocin, Indocin SR, Indo-Lemmon, Indomethagan)
- Ketoprofen (Oruvail)
- Ketorolac (Toradol)
- Mefenamic Acid (Ponstel)
- Meloxicam (Mobic)
- Nabumetone (Relafen)
- Naproxen (Naprosyn, Anaprox, Anaprox DS, EC-Naprosyn, Naprelan, Naprapac)
- Oxaprozin (Daypro)
- Piroxicam (Feldene)
- Sulindac (Clinoril)
- Tolmetin (Tolectin, Tolectin DS, Tolectin 600) 2
From the Research
Names of NASIDs Patch
- The names of NASIDs patches mentioned in the studies are:
- These patches are used for the treatment of various conditions such as:
- Osteoarthritis
- Rheumatoid arthritis
- Ankylosing spondylitis
- Myofascial pain syndrome
- Musculoskeletal pain
- The studies compared the efficacy and skin permeability of different NASIDs patches, with ketoprofen patch showing the most potent anti-inflammatory and analgesic activity 3
- The use of NASIDs patches has been shown to provide statistically and clinically significant pain relief for chronic musculoskeletal pain, although the evidence is of low certainty 5
- A randomized controlled trial compared ibuprofen, ketorolac, and diclofenac for the treatment of acute, nonradicular low back pain, but found no important differences between groups with regard to the primary outcome 6