Gel relieves pain in superficial joints

Dear Dr. Roach: You recently had several questions regarding using topical diclofenac gel (Voltaren) for arthritis pain. My doctor prescribed topical diclofenac for shoulder pain, but my insurance would not approve this item. Voltaren and diclofenac states do not use for back, hip or shoulder. Why not? What do you suggest I use for the shoulder other than pain pills?

G.T.S.

Answer: Topical antiinflammatories such as diclofenac gel are good alternatives and worth a try, as they have very low risk of systemic side effects and often give pain relief. However, they only penetrate so far into the body, and for that reason are most useful on joints that are superficial. The dose for lower extremity joints (feet, ankles and knees) is double the dose of the joints in the upper extremities (hands, wrists and elbows).

The back, hip and shoulder joints are generally deeper, and the manufacturer has not evaluated the effectiveness of diclofenac in these joints. Insurance companies will often not pay for treatments that have not been shown to be effective. It may still be effective for some individuals.

Other treatments that are helpful for osteoarthritis of the shoulder include exercises; oral anti-inflammatories; and Tylenol. Very severe shoulder arthritis is infrequently treated with joint replacement.

Dear Dr. Roach: I have Raynaud’s disease, a left bundle branch block and severe glaucoma. I am age 75, and I struggle to keep weight on. I experience low blood pressure and lightheadedness at times. Is the COVID-19 vaccine safe for me? My doctor’s reply to this question was that I “should be OK.” Will I be?

J.N.

Answer: Neither your doctor nor I can predict the future with certainty.

Reactions to the COVID-19 vaccine are rare (approximately 1 per 100,000 vaccines). I can say that none of your medical conditions puts you at increased risk for adverse effects from the vaccine.

Given the safety of the vaccine so far, and the terrible toll COVID-19 has already taken, I believe the benefits outweigh the risks.