Psoriatic Arthritis treatments: Topical Analgesics

Difflam contains the active ingredient benzydamine hydrochoride which belongs to the group of medicines known as non-steroidal anti-inflammatory drug (NSAID). It is used to treat pain caused by backache, rheumatic and muscular pain, sprains, strains, and neuralgia.

How does it work?

Benzydamine works by preventing the formation of prostaglandins. Prostaglandins are produced by the body and are responsible for inflammation features, such as swelling, pain, stiffness, redness and warmth.
 
Benzydamine also acts as a local anaesthetic, causing numbness and so pain relief at the site of application.

Who can get it?

Available for both adults and children from a pharmacy.

How is it used?

1-2 g of difflam should be massaged in lightly three times daily.  In severe cases up to six times daily.  The cream should not be used for more than 10 days

What are the side effects?

Like all medicines Difflam Cream can cause side effects, although not everybody will get them.  

You may experience any of the following
•    Itching
•    Skin rash
•    Skin redness or swelling
•    Difficulty breathing and wheezing
Some people become more sensitive to the effects of sunlight after using this cream.  This means that the skin may become red and painful after only a few minutes in the sun.  These side effects should disappear if you stop using the cream.

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Difflam is marketed in the UK by Meda

Felbinac is a type of medicine known as a non-steroidal anti-inflammatory drug (NSAID) used for the treatment of rheumatic and mild arthritic pain, sprains, strains and other soft tissue injuries

How does it work?

It works by blocking the production of a chemical (prostaglandin) which the body produces in response to injury or certain diseases. This prostaglandin would otherwise go on to cause swelling, pain and inflammation.

All the medicines in this group reduce inflammation caused by the body's own immune system and are effective pain killers.

Felbinac is applied to the skin surface (topically) for the relief of local pain and inflammation. It is used in many muscular and joint conditions such as in sprains, strains, rheumatism, and mild arthritic conditions.

The gel form of this medicine may be used in ultrasound as a coupling agent.

Who can get it?

Available on prescription for those over the age of 18.

How is it used?

Gently rub 1 g of gel or golf ball sized quantity of foam into affected area 2—4 times daily; maximum 25 g daily.
You should not cover the area being treated with airtight dressings such as bandages or other dressings, including nappies, as these will enhance the absorption of the medicine into the body and may increase the risk of adverse effects.
Avoid contact of this medicine with the eyes and the moist membranes lining the inside of certain parts of the body, e.g. mouth, nasal passages (mucous membranes). Rinse with cold water if accidental contact occurs.
Wash your hands thoroughly after applying this medicine, unless the hands are the area being treated.
The foam preparation is inflammable. Keep away from naked flames.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Mild local erythema,
• dermatitis,
• pruritus,
• paraesthesia

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Felbinac is marketed in the UK by Goldshield Pharmaceuticals Ltd and is known commercially as Traxam.

Feldene contains the active ingredient piroxicam, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are used to relieve pain and inflammation as seen in rheumatoid arthritis and osteoarthritis.

How does it work?

Piroxicam works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced by the body in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Piroxicam blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.
Piroxicam is used to relieve pain and inflammation in a wide range of musculoskeletal conditions, including various forms of arthritis, gout and muscle sprains and strains. It is also used to relieve pain and inflammation following orthopaedic (bone), dental and other minor surgery.

Piroxicam has a prolonged duration of action which means that one dose can provide pain relief throughout the day. You should try and take your dose at the same time each day.
Feldene capsules should be swallowed with a drink. Feldene dispersible tablets are designed to be dissolved in water before taking, but can also be swallowed whole with a drink. Feldene melt tablets are designed to dissolve quickly on the tongue and be swallowed with your saliva. These are convenient to take if you don't have a drink handy. They can also be swallowed whole with a drink. All these dose forms should preferably be taken with food to help reduce irritation to the stomach.
Feldene injection may be given for the initial relief of pain, but you will be switched onto oral treatment as soon as possible. The injection is given into the muscle of the buttock.

Who can get it?

This medicine is available on prescription for adults.

How is it used?

20mg each day. This dose may be decreased to 10mg each day (especially for elderly patients) or increased to 30mg each day. See the label on the pack to find out what dose you should take.
As your medicine helps to relieve the painful symptoms of arthritis it is usual for it to be taken for long periods of time. (Doses above 20mg daily for more than several days carry an increased risk of effects on the digestive system).

What are the side effects?

Effects on digestive system including:

• diarrhoea or constipation, wind.
• nausea, vomiting, loss of appetite.
• sore mouth and/or lips.
• stomach ache, indigestion, abdominal pain/discomfort.
• stomach (peptic) ulcers.

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Feldene is marketed in the UK by Pfizer Ltd.

Fenbid Gel contains the active ingredient ibuprofen which belongs to the group of medicines known as non-steroidal anti-inflammatory drug (NSAID). It is used to treat pain caused by backache, rheumatic and muscular pain, sprains, strains, and neuralgia.

How does it work?

Ibuprofen works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. NSAIDs block the production of these prostaglandins and are therefore effective at reducing inflammation and pain.

When ibuprofen is applied to the skin (topical application) it is absorbed through the skin into the underlying tissues, where it reduces pain and inflammation in the local area.

Fenbid gel and Fenbid forte gel can be used to relieve the pain of muscular and joint conditions such as sprains, strains, backache, rheumatism and minor arthritic conditions. They should be massaged gently into the affected area.

Ibuprofen is absorbed less into the bloodstream from preparations that are applied to the skin than from preparations that are taken by mouth (see end of factsheet), however absorption can still occur, particularly if large amounts are used on large areas.

Who can get it?

Available over the counter from most good chemists for adults and children over the age of 14.

How is it used?

For topical application over the affected area.
Massage in three to four times each day.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Skin rashes
• Abdominal pain
• Indigestion (dyspepsia)
• Allergic reactions such as asthma, narrowing of the airways (bronchospasm), swelling of the lips, throat and tongue (angioedema), itchy blistering rash or anaphylactic shock

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Fenbid Gel is marketed in the UK by Goldshield Pharmaceuticals Ltd

Ibugel contains the active ingredient ibuprofen which belongs to the group of medicines known as non-steroidal anti-inflammatory drug (NSAID). It is used to treat pain caused by backache, rheumatic and muscular pain, sprains, strains, and neuralgia.

How does it work?

Ibuprofen works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. NSAIDs block the production of these prostaglandins and are therefore effective at reducing inflammation and pain.

When ibuprofen is applied to the skin (topical application) it is absorbed through the skin into the underlying tissues, where it reduces pain and inflammation in the local area. Ibugel and Ibugel forte are aqueous/alcoholic gels, which also has an immediate cooling and soothing effect when applied to the affected area.

Ibugel can be used to relieve the pain of muscular and joint conditions such as sprains, strains, backache, rheumatism and minor arthritic conditions. It should be massaged gently into the affected area.

Ibuprofen is absorbed less into the bloodstream from preparations that are applied to the skin than from preparations that are taken by mouth however absorption can still occur, particularly if large amounts are used on large areas

Who can get it?

Ibugel is available in two strengths. 5% and 10%. The 5% strength can be bought over the counter or prescribed on NHS prescription whereas the stronger preparation can only be supplied on prescription.

How is it used?

For topical application over the affected joints.
Massage in three times each day.

What are the side effects?

None, However it should not be used in the following circumstances

• Broken, damaged, infected or diseased skin
• People in whom aspirin or other medicines in this class (NSAIDs), cause attacks of asthma, itchy rash (urticaria) or nasal inflammation (rhinitis)

Ibugel and Ibugel forte are not recommended for children under 12 years of age unless instructed by a doctor.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

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Ibugel is marketed in the UK by Dermal Laboratories Ltd.

Ibumousse contains the active ingredient ibuprofen which belongs to the group of medicines known as non-steroidal anti-inflammatory drug NSAID). It is used to treat pain caused by backache, rheumatic and muscular pain, sprains, strains, and neuralgia.

How does it work?

Ibuprofen works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Ibuprofen blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.

When ibuprofen is applied to the skin (topical application) it is absorbed through the skin into the underlying tissues, where it reduces pain and inflammation in the local area.

Ibumousse can be used to relieve the pain of muscular and joint conditions such as sprains, strains, backache, rheumatism and minor arthritic conditions. It should be massaged gently into the affected area.

Ibuprofen is absorbed less into the bloodstream from preparations that are applied to the skin than from preparations that are taken by mouth however absorption can still occur, particularly if large amounts are used on large areas.

Who can get it?

Ibumousse is available on NHS prescription and can be bought over the counter from most good chemists for adults.
Not suitable for children

How is it used?

For topical application over the affected area.
Massage in three to four times each day.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

•  Skin rashes
•  Abdominal pain
•  Indigestion (dyspepsia)
•  Allergic reactions such as asthma, narrowing of the airways (bronchospasm), swelling of the lips, throat and tongue (angioedema), itchy blistering rash or anaphylactic shock

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Ibumousse is marketed in the UK by Dermal Laboratories Ltd.

Ibuspray contains the active ingredient ibuprofen which belongs to the group of medicines known as non-steroidal anti-inflammatory drug (NSAID). It is used to treat pain caused by backache, rheumatic and muscular pain, sprains, strains, and neuralgia.

How does it work?

Ibuprofen works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Ibuprofen blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.

When ibuprofen is applied to the skin (topical application) it is absorbed through the skin into the underlying tissues, where it reduces pain and inflammation in the local area.

Ibuspray can be used to relieve the pain of muscular and joint conditions such as sprains, strains, backache, rheumatism and minor arthritic conditions. It should be massaged gently into the affected area.

Ibuprofen is absorbed less into the bloodstream from preparations that are applied to the skin than from preparations that are taken by mouth, however absorption can still occur, particularly if large amounts are used on large areas.

Who can get it?

Ibuspray is available on NHS prescription and can be bought over the counter from most good chemists for adults.
Not suitable for children

How is it used?

For topical application over the affected joint.
5—10 sprays to affected area 3 to 4 times daily.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Skin rashes
• Abdominal pain
• Indigestion (dyspepsia)
• Allergic reactions such as asthma, narrowing of the airways (bronchospasm), swelling of the lips, throat and tongue (angioedema), itchy blistering rash or anaphylactic shock

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Ibuspray is marketed in the UK by Dermal Laboratories Ltd.

Oruvail controlled release capsules and Oruvail injection contain the active ingredient ketoprofen, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID) and is used to treat pain caused by rheumatoid arthritis, osteoarthrosis, and ankylosing spondylitis.

How does it work?

Ketoprofen works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced by the body in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Ketoprofen blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.
Ketoprofen is used to relieve pain and inflammation in a wide range of musculoskeletal conditions, including various forms of arthritis, gout, muscle sprains and strains, back pain, neck pain and tendinitis. It can also be used to relieve period pain.
Oruvail injection may be given for the initial relief of acute musculoskeletal pain, but you will be switched onto oral treatment as soon as possible, preferably within three days. The injection is given into the muscle of the buttock.

Oruvail capsules are controlled release capsules. They are designed to release the ketoprofen slowly and continuously over several hours. This provides prolonged pain relief, so these capsules are taken once a day. The capsules must be swallowed whole to avoid damaging the controlled release action. Oruvail capsules should preferably be taken with food to help avoid irritating the stomach.

Who can get it?

Available on prescription for adults.

How is it used?

The usual adult dose is 1 to 2ml by injection into the muscle. This maybe repeated every 4 hours up to a maximum of 4ml in 24 hours. Treatment by injection is not normally continued for longer than 3 days. Elderly patients will normally be given the lowest effective dose.

Treatment by injection will usually be followed by a course of Oruvail capsules taken by mouth

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

•Wheezing or tightness of the chest
•Faintness

• Skin rash
• Sensitivity to sunlight
• Swollen ankles
• Bad stomach pains
• Vomiting blood or dark coffee coloured granules
• Passing dark tarry bowel motions
• Bruising on your body
• Yellowing of the skin, aching limbs
• Reduced urine levels, low pack pain

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Ketoprofen is known commercially as Oruvail and is marketed in the UK by Sanofi Aventis

Pennsaid belongs to the group of medicines known as non-steroidal anti-inflammatory drugs (NSAIDs) and is made up from the active ingredient of Diclofenac. It is used for the relief of pain associated with osteoarthritis of superficial joints.

How does it work?

Diclofenac works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced by the body in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Diclofenac blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.

When diclofenac is applied to the skin (topical application) it is absorbed through the skin into the underlying tissues, where it reduces pain and inflammation in the local area.

Pennsaid solution is used to relieve pain associated with osteoarthritis in superficial joints, such as the wrist or knee. There is no data on the use of Pennsaid for large, deep joints covered by layers of muscle or other soft tissues, such as the hip or spine.

Who can get it?

Available on prescription for those over the age of 18.

How is it used?

Apply 20—40 drops, depending on size of joint, in stages without rubbing in, repeat four times daily. The skin over the painful joint should be washed and dried before applying 20 – 40 drops of the solution. It should then be applied to the skin and spread evenly over the joint. The diclofenac will be absorbed into the underlying tissues of the joint where it will relieve pain.

What are the side effects?

Dry skin at application site, rash, possible systemic side effects if applied to large areas for prolonged periods. This medicine may cause dizziness and so may affect your ability to drive or operate machinery safely.
Pennsaid solution should not be taken by mouth. It is for application to the skin only.
Do not apply the solution to broken, damaged or infected skin. Do not apply to areas of skin that have been affected by skin diseases such as psoriasis, unless advised by your doctor. You should not cover the treated area with dressings.
Wash your hands after applying the solution, unless the hands are the area being treated.
Avoid contact of this medicine with the eyes and mucous membranes, such as the inside of the nose or mouth.
When diclofenac is applied to the skin it is absorbed into the bloodstream to a far lesser degree than diclofenac taken by mouth. This means it is much less likely to cause side effects on the gut than oral diclofenac. However, it is important that people with a history of disorders affecting the stomach or intestines are closely monitored by a doctor while using this medicine, particularly if elderly. Consult your doctor immediately if you experience side effects such as stomach pain, indigestion, heartburn or signs of bleeding in the stomach or intestines, e.g. blood in the stools, while using this medicine.
As it decreases pain and inflammation this medicine may mask the signs and symptoms of skin infections in the area that you apply it to. This may make you think mistakenly that an infection is getting better when it isn't, or that an infection is less serious than it is. For this reason you should tell your doctor if you get a skin infection in the area that you are using this medicine.
This medicine is not recommended for use in children

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Pennsaid is marketed in the UK by Dimethaid International.

Axsain cream is used to relieve the pain arising from nerves near to the surface of the skin. It belongs to a group of drugs known as topical analgesics.

How does it work?

Capsaicin is a compound which is present in the capsicum vegetable. The precise mechanism of action of capsaicin is not fully understood, however it is believed that it relieves pain by reducing and preventing the re-accumulation of a chemical called Substance P which is found in pain receptor nerve cells in the body. This is believed to be the main chemical responsible for sending pain signals from the body to the brain.

Who can get it?

Axsain is not suitable for children

How is it used?

Axsain should be applied sparingly three or four times daily or as prescribed by your doctor.
Avoid contact with eyes, and inflamed or broken skin. Hands should be washed immediately after use. Not for use under tight bandages. Avoid taking a hot shower or bath just before or after applying capsaicin as the burning sensation enhanced

Axsain should not be used in children.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
Axsain cream can cause a brief burning feeling when applied. This burning is more
common when:

• The cream is used less than 3 or 4 times a day.
• Too much cream is applied.
• The cream is applied just before or after a hot bath or shower.

Rarely when Axsain cream is applied the vapour can cause brief irritation of the eyes, nose, and throat, such as runny nose, cough or sneezing, breathlessness or worsening of asthma.
Axsain may cause local skin reactions (e.g. contact dermatitis) due to the product containing cetyl alcohol.
If any of the side effects become serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

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Capsaicin is available on prescription and is commercial known as Axsain. It is marketed in the UK by Cephalon Ltd

Balmosa is a warming pain relieving cream that contains a combination of menthol, camphor, methyl salicylate and oleoresin capsicum as active ingredients and is used in the treatment of muscular rheumatism, fibrositis, lumbago, sciatica and unbroken chilblains.

How does it work?

Menthol relieves itching and causes the blood vessels on the surface of the skin to widen. This causes a sensation of coldness followed by a reduction in pain.

Camphor, methyl salicylate and oloeresin capsicum are counter-irritants, which when applied, cause redness and heat to be produced. This distracts the brain from the original pain and therefore reduces the perception of pain.

Who can get it?

Available over the counter for adults.  Not recommended for use in children

How is it used?

Massage in as and when required.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

•  Skin reactions such as rash and itch

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Balmosa  is marketed in the UK by Galen Consumer

Qutenza is a self adhesive pad containing the active ingredient capsaicin and it  belongs to a group of drugs known as topical analgesics.

How does it work?

Capsaicin is a compound which is present in the capsicum vegetable. The precise mechanism of action of capsaicin is not fully understood, however it is believed that it relieves pain by reducing and preventing the re-accumulation of a chemical called Substance P which is found in pain receptor nerve cells in the body. This is believed to be the main chemical responsible for sending pain signals from the body to the brain.

Who can get it?

Qutenza is available on prescription for adults only.  

How is it used?

After pre-treatment of the affected area with topical anaesthetic, up to 4 patches should be applied by a healthcare professional to painful areas for up to 30 minutes (feet) or 60 minutes (other areas).  Repeat after 90 days if necessary

What are the side effects?

LIke all medicines, Qutenza can cause side effects, although not everybody gets them.
The frequency of possible side effects listed below is defined using the following convention:
Very common(affects more than 1 user in 10)
Common (affects 1 to 10 users in 100)
Uncommon (affects 1 to 10 users in 1,000)

Very common side effects:

• redness, pain on the area where the patch is applied

Common side effects:

• itching, bumps, blisters, swelling, dryness on the area where the patch is applied

Uncommon side effects:

•  Wheals, prickling sensation, inflammation of the, skin, increased sensitivity, inflammation, skin reaction, irritation, bruising on the area where the patch is applied.
• high blood pressure, slowing of the electrical signals in the heart, rapid beating of the heart,  abnormal awareness of the beating of the heart, decreased taste, reduced sensations in limbs,  burning sensation, eye irritation, cough, throat irritation, nausea, itching, pain in limbs, muscle spasms, shingles, swelling of limbs.

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Qutenza is marketed in the UK by Astellas

Zacin cream is for the treatment of mild to moderate pain caused by osteoarthritis. It belongs to a group of drugs known as topical analgesics.

How does it work?

Capsaicin is a compound which is present in the capsicum vegetable. The precise mechanism of action of capsaicin is not fully understood, however it is believed that it relieves pain by reducing and preventing the re-accumulation of a chemical called Substance P which is foudn in pain receptor nerve cells in the body. This is believed to be the main chemical responsible for sending pain signals from the body to the brain.

This strength of capsaicin when applied to the skin is used to relieve the pain associated with osteoarthritis.

Who can get it?

Zacin is not suitable for children. It is available on prescription.

How is it used?

Zacin should be applied sparingly four times daily.
Avoid contact with eyes and inflamed or broken skin such as in an open wound. Hands should be washed immediately after use. Not for use under tight bandages. Avoid taking a hot shower or bath just before or after applying capsaicin as the burning sensation may be enhanced.

Zacin should not be used in children.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
Zacin may cause a transient burning sensation following application. This sensation generally disappears after several days of treatment, but may persist particularly when application schedules of less than 4 times daily are used. The burning can be enhanced if too much cream is used or if it is applied just before or after a bath or shower.

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Zacin is available on prescription for adults. It is marketed in the UK by Cephalon Ltd