Voltaren…just another topical gel?

Over the years in my office the question of which topical cream or gel is best or what which one do  I recommend, is one of the most common ones.

All topical rubs (Tiger Balm, Deep Relief,  A535, Icy Hot, Bio Freeze) work on the same premise known as the “GateTheory” of pain control. Their active ingredients (menthol, camphor, methyl salicilate) act as counterirritants which trick the brain into paying more attention to the warming or cooling sensation than to pain.

As far as which one is best, it is purely preference.  They can work differently for each person.  In my office I like BioFreeze because it seems to work best for most people.

Over the last number of months patients have been asking about a new topical rub called Voltaren. Is it just another rub like the others… absolutely NOT. Here’s why.

Voltaren is the brand name for a drug called Diclofenac. Diclofenac is a pain reliever in the drug class NSAID (non-steroidal anti-inflammatory drug). Voltaren can be taken orally (diclofenac potassium) or used as a topical rub (diclofenac sodium)

How NSAIDs Work.

All non-steroidal anti-inflammatory drugs like Advil (ibuprofen),  Motrin,  Aleve (naproxen), Celebrex and  including diclofenac sodium  are designed to inhibit activity of COX-1 and COX-2 enzymes, which cause the pain. This enzymes are produced by the cells of the body, and are responsible for the creation of the agents called prostaglandins, which promote inflammation, pain and fever

Diclofenac is a nonselective NSAID, which means that it blocks both COX-1 and COX-2 to stop the production of more types of prostaglandins than some other NSAIDs. This means that it is more likely to cause side effects due to the action of the other prostaglandins that are reduced.

Obviously a topical rub is less likely to produce side effects than oral intake but let’s cover them anyway.


Heartburn (dyspepsia)




Gastrointestinal ulcer

Gastrointestinal bleeding


So is Voltaren topical gel safe and effective? Because so little of the active ingredient is absorbed into the rest of the body (6-10%) it appears to be safe from side effects.

Voltaren topical gel appears to be very effective for knees, feet & hands, elbows, shoulders and back) pain.