NSAIDs worth trying before meds

Dear Dr. Roach: Since topical applications of creams are absorbed into the bloodstream and circulate, and do not go directly to the site of pain, is thereanadvantage to using them over oral NSAIDs?— T.A.W.

I disagree with your premise. Although topical NSAIDs do get absorbed by the body, they are absorbed much less well than oral doses. Only 6% to 20% of the dose gets into the bloodstream.

The benefit is not immense, but 60% of people will have pain reduced by half or more using topicalNSAIDs. The biggest barrier I have had to them has been their high cost. However, generic diclofenac (Voltaren) gel is around $15 with theGoodRxapp. They are worth trying before oral NSAIDs, especially on parts of thebodywhere the joint pain is superficial. They have much less risk of damage to the stomach and kidneys. Mild skin rash is the most common side effect.

Dear Dr. Roach: Where should the top of my compression stocking be? I was told by the salespeople that the top should be about 2 inches belowthe bend in the knee. But there is extra pressure that could cut off the blood flow.— P.A.

The ideal top of the compression stocking depends on howhigh theswelling goes. For most people with lower-limb swelling that comes from changes in the veins due to getting older— when the valves in the veins fail, leading to varicose veins and leg swelling — below the knee is a common site. For other people, thigh high is more appropriate.

You do not need to worry about cutting off circulation. The blood supply to the legs comes fromthe arteries, which are at much higher pressure. However, you canmake the top a little higher if it is more comfortable for you.

Doubling of material is not recommended, since modern stockings have less pressure.