Formulations of topical diclofenac, ibuprofen, ketoprofen, piroxicam, and indomethacin demonstrated significantly higher rates of clinical success (more participants with at least 50% pain relief) than matching topical placebo (moderate or high quality data ). Benzydamine did not. Three drug and formulation combinations had NNTs for clinical success below 4. For diclofenac, the Emulgel® formulation had the lowest NNT of (95% CI to ) in two studies using at least 50% pain intensity reduction as the outcome . Diclofenac plasters other than Flector® also had a low NNT of ( to ) based on good or excellent responses in some studies. Ketoprofen gel had an NNT of ( to ), from five studies in the 1980s, some with less well defined outcomes. Ibuprofen gel had an NNT of ( to ) from two studies with outcomes of marked improvement or complete remission. All other drug and formulation combinations had NNT values above 4, indicating lesser efficacy .
Topical gels have been shown to reduce the need for oral analgesics which is a good thing for reducing side trial found that topical capsaicin reduce pain more than placebo in people with AS, although it can cause burning sensations. Another trial used a gel form of a drug called tenoxicam (an NSAID) that suggested it might be helpful. Do ask your specialist if you can try something like voltarol – or a stronger version on prescription – and follow their individual advice. They may prefer you to have some oral anti-inflammatory on board to reduce inflammation throughout the body, however.
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