From the Guidelines
Topical Treatments for Acute Gout
Topical ice application is a recommended adjunctive measure for the treatment of acute gouty arthritis 1.
Key Topical Treatments
- Topical ice packs or cold compresses can be applied for 15-20 minutes, 3-4 times daily, to help reduce pain and inflammation 1. Note that other topical treatments like capsaicin cream or diclofenac sodium gel may be considered, but the provided evidence does not specifically support their use for acute gout 1.
Important Considerations
When managing acute gout, it is essential to consider a combination of non-pharmacological and pharmacological treatments, taking into account the clinical phase, serum uric acid level, frequency of previous attacks, and associated comorbidity and risk factors 1.
From the FDA Drug Label
Directions Adults and children 18 years of age and older: Apply a thin film of cream to affected area and gently rub in until fully absorbed. For best results, apply 3 to 4 times daily.
Diclofenac sodium topical solution is not a substitute for low dose aspirin for cardiovascular protection.
The topical treatments for acute gout are:
- Capsaicin (TOP): Apply a thin film of cream to the affected area 3 to 4 times daily 2
- Diclofenac sodium (TOP): Although the label does not explicitly state it is for gout, it is a topical NSAID that may be used for pain relief 3
From the Research
Topical Treatments for Acute Gout
There are no research papers provided that directly address the topical treatments for acute gout. The studies available focus on the use of capsaicin for managing chronic pain conditions such as neuropathic pain, osteoarthritis, and musculoskeletal disorders.
Capsaicin for Chronic Pain Management
- Capsaicin has been found to be effective in reducing pain intensity for chronic conditions, with studies indicating its potential benefits for osteoarthritis pain 4, 5.
- The efficacy of capsaicin for neuropathic pain is less clear, with some studies suggesting moderate efficacy 6, 7 and others indicating it may not have a significant effect beyond placebo 6.
- Topical capsaicin treatments are generally well-tolerated, with common adverse events including application site discomfort, erythema, and burning, which often diminish over time 8, 4, 7, 5.
Dosage and Application
- Different concentrations of capsaicin have been studied, ranging from 0.025% to 0.25%, with varying application frequencies 4, 5.
- Higher concentrations of capsaicin, such as 0.25%, may provide more rapid onset of action and improved efficacy when applied twice daily 5.
- Lower concentrations, like 0.075%, have shown moderate effectiveness in reducing pain intensity for chronic conditions 4, 7.