For knee pain, your best over-the-counter option is a topical anti-inflammatory gel containing diclofenac, sold as Voltaren Arthritis Pain. It’s the only topical pain reliever with strong clinical evidence for joint pain, and it’s available without a prescription. Beyond that, you have several other options worth considering, from capsaicin cream to simple ice and heat, depending on the type of pain you’re dealing with.
Topical Anti-Inflammatory Gel
Diclofenac gel (the active ingredient in Voltaren Arthritis Pain) is a non-steroidal anti-inflammatory drug, or NSAID, that you rub directly onto your knee. It works the same way ibuprofen does, reducing inflammation and pain, but because it’s absorbed through the skin rather than swallowed, far less of the drug enters your bloodstream. That means fewer stomach and cardiovascular side effects compared to popping pills.
The over-the-counter version is a 1% gel. For each knee, you squeeze out a line of gel equal to about 4.5 inches on the dosing card included in the box, then rub it in. You can apply it up to four times daily for up to 21 days without a doctor’s guidance, and on up to two body areas at once (both knees, or one knee and one ankle, for example). Prescription-strength versions are also available as liquid solutions at 1.5% and 2% concentrations. The gel works best for osteoarthritis and general aching rather than deep internal injuries.
Give it a few days to build up. Some people feel relief within the first application, but the full anti-inflammatory effect often takes a week or so of consistent use.
Capsaicin Cream
Capsaicin is the compound that makes chili peppers hot, and in cream form it gradually dulls pain signals. It works by depleting a chemical messenger called substance P from the nerve endings in your skin. Without substance P, those nerves have a harder time sending pain signals to your brain.
Over-the-counter capsaicin creams typically come in 0.025% or 0.075% concentrations. You apply a small amount to your knee four times a day. The catch: it burns. Most people feel a mild to moderate burning sensation on the skin during the first week or two. This fades with continued use as the nerve endings become desensitized. Clinical trials show that capsaicin takes about four weeks of consistent application before you can judge whether it’s helping. If you quit after a few days because of the burning, you won’t get the benefit.
To avoid accidentally spreading capsaicin to your eyes or other sensitive areas, wash your hands thoroughly after every application, or use gloves.
Lidocaine Patches
Lidocaine is a numbing agent, and patches that deliver it through the skin can help with localized knee pain. A 5% lidocaine patch is applied once daily directly over the most painful area of your knee. In clinical studies on knee osteoarthritis, patients using lidocaine patches reported improvements in pain, stiffness, and physical function. Doctors typically prescribe a maximum of four patches per day, covering as much of the painful region as possible.
Lower-concentration lidocaine patches and creams (around 4%) are available over the counter. These are better suited for surface-level pain and may not penetrate deeply enough for significant joint relief, but they can take the edge off. Lidocaine doesn’t reduce inflammation. It simply blocks pain signals temporarily, so it’s best used alongside other approaches.
Ice and Heat
Temperature therapy costs nothing and works surprisingly well, especially for acute flare-ups. The key is knowing which one to reach for.
Ice is your go-to for sharp pain, fresh injuries, and visible swelling. It constricts blood vessels, slows inflammation, and numbs the area. Heat is better for stiffness, chronic aches, and muscles that feel tight around the knee. It increases blood flow and relaxes tissue. If your knee is swollen and warm to the touch, skip the heat.
Follow the 20/20 rule: apply ice or heat for no more than 20 minutes, then give yourself a 20-minute break before reapplying. Always put a cloth or towel between ice packs and your skin to prevent frostbite. For morning stiffness from arthritis, a warm towel or heating pad before you get moving can make a noticeable difference.
What About CBD and Arnica?
CBD topicals are widely marketed for joint pain, but the clinical evidence is thin. In a randomized, double-blinded trial published in The Journal of Arthroplasty, 80 patients applied either topical CBD, essential oils, a combination of both, or a placebo to their knees three times daily for two weeks after knee replacement surgery. The result: no significant differences in pain scores, sleep quality, or painkiller use between the CBD group and the placebo group. The CBD group actually reported slightly higher pain scores on the second day compared to the essential oil group.
Arnica gel is another popular natural option. Some people find it soothing for bruises and mild soreness, but robust clinical evidence for knee joint pain is limited. Neither CBD nor arnica is likely to cause harm when applied to the skin, but if you’re spending significant money on these products expecting strong pain relief, the evidence doesn’t support that expectation.
Menthol and Counterirritant Rubs
Products like Bengay, Icy Hot, and Biofreeze contain menthol, camphor, or methyl salicylate. These are called counterirritants: they create a cooling or warming sensation on the skin that distracts your brain from the deeper pain underneath. They don’t treat inflammation or heal anything, but they can provide temporary relief for 30 to 60 minutes and feel good in the moment. They’re fine to use between applications of a more targeted treatment like diclofenac gel, but don’t apply them at the same time or layer products on the same patch of skin.
Getting the Most From Topical Treatments
Clean, dry skin absorbs topical treatments better. Apply your gel or cream to freshly washed skin, and avoid covering the area with tight bandages unless the product’s directions say otherwise. Don’t apply any topical pain product to broken skin, open wounds, or rashes.
If you’re using diclofenac gel, avoid combining it with oral NSAIDs like ibuprofen or naproxen unless a doctor has cleared it. Even though topical NSAIDs have lower systemic absorption, doubling up increases the risk of side effects like stomach irritation.
Topical treatments work well for pain that’s close to the surface, which is one reason they’re effective for knees. The knee joint sits just beneath the skin without much muscle or fat covering it, so gels and creams can actually reach the tissue where inflammation is happening.
Signs Topical Treatment Isn’t Enough
Topical remedies are a reasonable first step for mild to moderate knee pain, especially from arthritis or minor overuse. But certain symptoms signal something that a cream or ice pack can’t fix. Seek medical attention if your knee gives out or feels unstable when you put weight on it, if you see obvious deformity in your leg or knee, if you can’t fully bend or straighten it, or if you have significant swelling that doesn’t improve. A fever combined with redness, pain, and swelling could indicate an infection in the joint, which requires urgent care. Severe knee pain following an injury also warrants evaluation, since ligament tears and fractures need imaging to diagnose properly.