Pain from arthritis in women most commonly occurs in the hands, knees, hips, lower back, and neck. With the hands, the pain usually starts in the thumb joint, the carpometacarpal joint. Oral NSAIDs (non-steroidal anti-inflammatory drugs) work well but can irritate the stomach lining and cause problems with the kidneys. It turns out, topical patches and creams are safe, effective alternatives for arthritis pain. Here’s what works.
Flector Patch (Diclofenac patch)
Flector is a prescription patch of the topical NSAID Diclofenac and, in studies, is the most effective for pain relief. Patches are changed every 12 to 24 hours, but they are expensive and often not covered by insurance. Make sure you shop around for the best cash price using GoodRx.com. These work
Voltaren gel (Diclofenac gel)
This topical NSAID is now available over the counter, and a 5.3 oz tube (150-gram tube) will cost around $25. Shop around because if your doctor sends it as a prescription, you can also pay cash for it using GoodRx and save some money. Applied 3-4 times daily to the hands, feet, or knees, Voltaren gel effectively relieves pain.
Pennsaid (Diclofenac solution)
Available as a prescription, diclofenac solution (Pennsaid) is a liquid formulation best studied for knee arthritis. Topical diclofenac solution is applied directly to the area of pain, two pumps two times a day, for treatment of symptoms associated with osteoarthritis of the knee. Again, insurance may not cover it, so you’ll search for the cash pay price, which can be as low as $28 a bottle.
Lidocaine patches: over-the-counter or prescription?
For localized areas, lidocaine patches are effective at relieving pain. What’s new here is that a stronger over-the-counter 4% lidocaine is now available combined with menthol (Salonpas). Prescription lidocaine 5% patches work well, but the over-the-counter options are equivalent for pain relief in comparison studies. Read on.
Lidoderm patches (5% lidocaine) are available by prescription only and applied to the painful area for up to 12 hours within a 24 hour period. You can cut patches into smaller sizes with scissors, but the gels and solutions are often easier to use than the patches. Insurance companies don’t like to cover these (see a theme here), but a pro-tip here is that a box of 30 patches can be as low as $48-50 dollars using GoodRx.com with a prescription from your doctor.
Salonpas Lidocaine 4% gel patches are now over the counter.
An attractive new item because it’s easily available over-the-counter. The patches are changed once or twice daily, and six patches are around 30 dollars, so another pro-tip here is that paying cash for Lidoderm patches with a prescription from your doctor may be a better alternative. Lidoderm patches are 5% lidocaine (vs. 4% in the over-the-counter form) and last longer, oh, and it’s cheaper with the cash pay price.
Hope this helps
I am a Clinical Associate Professor of Medicine at the Keck School of Medicine of USC and a board-certified Internal Medicine physician. For 20 years I’ve had an active private practice in general internal medicine currently at The Doctors of USC Beverly Hills. I am lucky to spend part of my time as the attending physician for medical students and residents during their rotations at LAC+USC Medical Center. I’ve been a medical advisor on leading health social networking sites including Dailystrength.org and Sharecare and currently serve as the medical advisor and blogger for GoodRx.com, a prescription drug price comparison website, and GoodRx care powered by Hey Doctor.
My philosophy of care centers around seeing things we can see coming, and nailing them head-on. I appreciate the idea of sharing power and responsibility for the choices one makes for prevention, treatment, and investigation into medical problems. My hope is to write blog posts to empower patients to navigate their own health by laying out the ways that medicine can guide you with strategies to investigate, prevent, and treat some common medical issues, big and small.
I have appeared on The Doctors, Fox Sports West, The Ricki Lake Show, as well as many local news outlets and have been featured in numerous online and print publications. I am a fellow of the American College of Physicians and honored to be named “Top Doctor” in Los Angeles and Pasadena Magazine for years.