Apply to the affected area and massage into the skin gently. Always wash your hands after you have finished rubbing the cream, gel or spray into the skin. This is to make sure that you avoid rubbing this medicine into sensitive areas of the body such as the eyes. Do not apply to skin that is broken, or near the eyes, nose, mouth, genital or bottom (anal) areas. Do not use plasters or bandages (dressings) on top of these medicines. Generally these medicines are applied to the skin 2-4 times a day. However, for specific advice for your medicine, see the leaflet that comes inside the packet.
Information was available from 7688 participants in 34 studies from 32 publications; 23 studies compared a topical NSAID with placebo. Topical NSAIDs were significantly more effective than placebo for reducing pain due to chronic musculoskeletal conditions. The best data were for topical diclofenac in osteoarthritis, where the NNT for at least 50% pain relief over 8 to 12 weeks compared with placebo was for the solution, and 11 for the gel formulation. There were too few data of good quality to calculate NNTs for other individual topical NSAIDs compared with placebo. Direct comparison of topical NSAID with an oral NSAID did not show any difference in efficacy. There was an increase in local adverse events (mostly mild skin reactions) with topical NSAIDs compared with placebo or oral NSAIDs, but no increase in serious adverse events. Gastrointestinal adverse events with topical NSAID did not differ from placebo, but were less frequent than with oral substantial amount of data from unpublished studies was unavailable. Much of this probably relates to formulations that have never been marketed.