Topical NSAIDs worth trying before oral meds

DEARDR. ROACH » Since topical applications of creams like Voltaren or Aspercream are absorbed into the bloodstream and circulate throughout the body, and do not go directly to the site of pain, is there an advantage to using them over oral NSAIDs?

— T.A.W.

DEARREADER » 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, and there is definitely an effect locally.

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

DEARDR. ROACH » Where should the top of my compression stocking be? I was told by the salespeople that the top should be about 2 inches below the bend in the knee. But there is extra pressure that could cut off the blood flow at this location. It is a very thick part of my calf, and having to double over the material increases the pressure there. Having the stocking end inside the bend of my knee (behind the knee) seems to exert less pressure.

— P.A.

DEARREADER » The ideal top of the compression stocking depends on how high the swelling goes. For most people with lowerlimb 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, especially after a long day or excess salt intake — 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 from the arteries, which are at much higher pressure than the veins or the compression stockings. However, you can make the top a little higher if it is more comfortable for you, and if behind the knee is comfortable, than that should be fine.

Doubling of the material is not recommended, since modern stockings have less pressure at the top for comfort.