Why Choose a Topical First
International guidelines now recommend topical anti-inflammatories as first-line drug treatment for hand and knee osteoarthritis. Drug levels in the bloodstream are roughly 5% of those reached by tablets, so stomach, kidney and cardiovascular risks are dramatically reduced. For people over 65 or with high blood pressure, ulcers or kidney disease, a cream is often the safer route to comparable pain relief.
Topical NSAIDs (Diclofenac, Ibuprofen, Ketoprofen)
Topical diclofenac gel has the strongest evidence base for knee and hand OA, with pain reduction comparable to oral ibuprofen in head-to-head trials. Apply a 2-4 g dose (roughly the length of the affected joint) three to four times a day for at least two weeks before judging effect. Wash hands after use and avoid broken skin.
Capsaicin Cream
Capsaicin, derived from chilli peppers, depletes the pain neurotransmitter substance P over 1-2 weeks of consistent use. Low-strength 0.025% creams are available without prescription. Expect a warm tingling for the first few applications. Best for hand OA and small-joint pain; not suitable for broken skin or near the eyes.
Menthol, Camphor and Methyl Salicylate Rubs
These create a cooling or warming counter-irritant effect that distracts the nervous system from joint pain for 30-60 minutes. Evidence is modest but real, and they are useful before exercise or sleep. Avoid combining with a heat pad — burns can occur.
How to Apply for Best Results
Wash and dry the skin. Massage in for 1-2 minutes until absorbed. Do not bandage tightly or apply heat over the top. Use consistently for at least two weeks before deciding whether it works. Combine with paced activity, splints or our hand exercises for hand OA.
When Creams Are Not Enough
If pain still wakes you at night, prevents stairs or limits dressing despite two weeks of consistent use, see your GP. Options include oral medication, physiotherapy, joint injection or surgical review. Read our pain management guide for the full ladder of treatments.