Topical NSAIDs in later life: safer pain relief for knee and hand osteoarthritis (UK guide)

Name: Topical NSAIDs in Later Life: Knee and Hand OA (UK)
Creator: Louis Maxwell

Written by Louis Maxwell — First Contact Practitioner, HCPC PH128483.

Clinical review status: not yet recorded

Topical NSAIDs are anti-inflammatory gels, creams and sprays, such as ibuprofen or diclofenac gel, that you rub into a painful joint. NICE recommends offering a topical NSAID for knee osteoarthritis and considering one for other joints, including the hands, before tablets. Much less of the medicine reaches the rest of the body than with tablets, which is why they often suit people in later life who take other medicines or have kidney, heart or stomach problems — but they are not risk-free. Use the amount and number of times a day on the leaflet, keep it off broken skin, wash your hands…

This guide is for people in later life — and their carers — using gels on sore knees or hands, often alongside other medicines. For a general introduction to how anti-inflammatory gels work and the common mistakes people make, see topical NSAIDs: often overlooked, often effective. For tablets, see painkillers in later life.

Who topical NSAIDs suit

Knee osteoarthritis: NICE says to offer a topical NSAID for knee osteoarthritis, alongside exercise and other self-care
Hand and other joints: NICE says to consider a topical NSAID for osteoarthritis in other joints. Hand joints sit close to the skin, so many people find gels worth trying for finger and thumb-base pain
Later life and other conditions: because less medicine reaches the bloodstream, a gel is often a safer first choice than NSAID tablets for people who have had stomach problems or who have kidney or heart conditions. It is still worth checking with a pharmacist

Gels work best for one or two sore joints. They are not designed for pain all over, and they do not slow down osteoarthritis — exercise remains the main treatment. See knee exercises for osteoarthritis and grip exercises for hand osteoarthritis.

How to use a gel safely

Follow the leaflet for how much to use and how many times a day. Do not use more often than it says
Rub it gently into clean, unbroken skin over the sore joint until it has soaked in
Wash your hands afterwards — unless it is your hands you are treating — and keep it away from your eyes and mouth
Do not cover the area with a tight bandage or put a heat pack on top straight after
Give it a fair trial. If it has not helped after a couple of weeks of regular use as the leaflet describes, talk to a pharmacist or GP rather than using more

Fire safety

The NHS warns that clothes and bedding that have been in contact with ibuprofen gel or spray can burn more easily. Do not smoke or go near naked flames, gas fires or heaters after using it, and wash clothing and bedding regularly. This matters most for anyone who uses a gel every day, or who is less mobile and spends long periods in a chair or bed.

Skin in later life

Older skin is thinner and more easily irritated. Stop and speak to a pharmacist if you get a rash, itching, redness or blistering
Some gels, including diclofenac, can make skin more sensitive to sunlight — check the leaflet and keep treated skin out of strong sun
Never put gel on broken, infected or very fragile skin, or on eczema

Check with a pharmacist first if you

take a blood thinner such as warfarin, apixaban or rivaroxaban, or take steroid tablets
have asthma that has been made worse by aspirin or other NSAIDs, or have had a reaction to an NSAID
have kidney disease, heart failure or have had a stomach ulcer or bleed
already take NSAID tablets such as ibuprofen or naproxen, or regular aspirin. Do not use NSAID gel and NSAID tablets together unless a doctor has said so
take several regular medicines. A pharmacist medication review can check everything together

For more on why tablets need more caution, see NSAIDs, kidneys and the heart and stomach protection with NSAIDs. Never stop or change a prescribed medicine yourself — ask your GP or pharmacist first.

When your hands are sore too

Tubes can be hard to squeeze with hand osteoarthritis. Pump dispensers, sprays or a tube squeezer can help — ask your pharmacist what forms are available
If you are treating your hands, apply it after washing them, and avoid touching your eyes until it has soaked in
A carer can apply gel for you. They should wash their hands afterwards. Disposable gloves can help if they apply it often

For other everyday hand tips, see hand osteoarthritis: dressing and cooking.

Other options to talk about

Heat or cold: a warm pack or a cold pack wrapped in a towel can ease pain, used for short spells and never directly on the skin. See heat or ice?
Capsaicin cream: a chilli-based cream sometimes prescribed for knee and hand pain. It can sting at first and takes regular use to work, so ask a pharmacist or GP
Exercise and weight: NICE puts tailored exercise first for everyone with osteoarthritis

When to get help

See a pharmacist or GP if pain is not improving, is getting worse, or is affecting sleep or getting about
Contact NHS 111 if you have accidentally swallowed gel and feel unwell, or think you are having a serious side effect such as black, tarry poo, or new ankle swelling with breathlessness
Call 999 if you have signs of a severe allergic reaction, such as a swollen tongue or throat or difficulty breathing
See a GP urgently if a joint is suddenly hot, red and very swollen, or you feel feverish and unwell — this is not usual osteoarthritis pain

You can report side effects to the MHRA Yellow Card scheme.

Common questions

Can I use gel and take paracetamol?

Usually, yes, as they are different medicines — but check with a pharmacist, especially if you take other painkillers or combination products, so you know your total intake is safe.

Is a gel "weaker" than tablets?

For a single knee or hand, it can work well, with fewer side effects. It is not meant for widespread pain.

Sources and further reading

Educational information for people in the United Kingdom — not a diagnosis or personal medical advice. Charity no. 1218461. Pending clinical review. Everyone's situation is different, so always follow the advice of your own GP, pharmacist, physiotherapist or rheumatology team. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.

Continue with related help

Topical NSAIDs explained — how gels work
Painkillers in later life — safer use of tablets
Painkillers and NSAIDs — our guide
Grip exercises — for hand osteoarthritis
Knee exercises — for knee osteoarthritis

Last updated 2026-10-23. This is general information, not a substitute for personalised medical advice.