Diclofenac gel is the most effective and well-studied topical cream for arthritis pain. It’s the only topical treatment strongly recommended by the American College of Rheumatology for osteoarthritis, and clinical evidence shows it provides short-term pain relief equivalent to oral anti-inflammatory pills, with far less risk to your stomach and cardiovascular system. It’s available over the counter as Voltaren Arthritis Pain gel (1%) and in stronger prescription formulations.
That said, topical creams work best on joints close to the skin’s surface, particularly hands and knees. If your arthritis is in a deeper joint like the hip or spine, topical treatments won’t penetrate well enough to help much. For those shallow, accessible joints, though, you have several solid options worth understanding.
Diclofenac Gel: The Strongest Evidence
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that reduces both pain and inflammation right at the joint. When applied to the skin, it reaches high concentrations in the tissue underneath while producing 5 to 17 times less drug circulating through your bloodstream compared to taking the same medication as a pill. That’s a meaningful safety advantage, especially if you’re older or have a history of stomach ulcers, kidney problems, or heart disease.
The over-the-counter version (1% gel) comes with a dosing card to help you measure the right amount. For upper body joints like a hand, wrist, or elbow, you squeeze out a line of gel about 2.25 inches long. For lower body joints like a knee, ankle, or foot, the line should be about 4.5 inches. You apply it four times a day for best results, rubbing it evenly over the joint.
A few practical rules make a real difference in how well it works. Wait at least 10 minutes before covering the treated area with clothing or gloves. Don’t use a heating pad on the area or wrap it with a bandage. Avoid showering for at least 30 minutes after application. And protect the treated skin from direct sunlight.
If the OTC gel isn’t providing enough relief, your doctor can prescribe stronger formulations. Pennsaid is a prescription-strength diclofenac solution specifically approved for knee osteoarthritis, applied as 40 drops per knee four times daily. Diclofenac also comes in patch form, applied twice a day, which can be more convenient if you don’t want to deal with gel on your hands.
Capsaicin Cream: A Different Approach to Pain
Capsaicin, the compound that makes chili peppers hot, works through a completely different mechanism than anti-inflammatory creams. Rather than reducing inflammation, it gradually disables the pain-sensing nerve endings in your skin. With repeated use, those nerve fibers lose their ability to transmit pain signals, a process researchers call “defunctionalization.” The nerve endings temporarily retract from the skin’s surface and lose their capacity to fire.
This takes time. Capsaicin cream causes a burning or stinging sensation during the first week or two of use, which is the most common reason people quit before it starts helping. If you push through that initial discomfort and apply it consistently (typically three to four times daily), the burning fades as the nerve endings become less reactive. Most people notice meaningful pain relief after two to four weeks of regular use.
Capsaicin creams are available over the counter in low-concentration formulations and don’t require a prescription. They’re a reasonable option if you can’t tolerate NSAIDs or want something to use alongside diclofenac for additional relief.
Menthol and Methyl Salicylate Products
Products like Bengay, Icy Hot, and Aspercreme with menthol fall into the “counterirritant” category. Menthol creates a cooling sensation, and methyl salicylate (related to aspirin) produces warmth. Both compounds activate specific receptors in the skin that essentially compete with pain signals, distracting your nervous system from the deeper joint ache.
These products provide genuine short-term relief, often within minutes of application. They’re useful for flare-ups or as a complement to other treatments. The effect doesn’t last as long as diclofenac or capsaicin, and they don’t address inflammation directly. Think of them as fast-acting comfort rather than a primary treatment strategy. They’re applied two to four times daily, depending on the product.
Lidocaine Patches
Lidocaine is a numbing agent that blocks nerve signals in the area where it’s applied. In a clinical trial of 143 patients with knee osteoarthritis, lidocaine patches performed as well as the prescription oral anti-inflammatory celecoxib over 12 weeks. In both groups, 71% of patients reported at least a 30% improvement in pain, which is considered clinically meaningful.
Lidocaine patches are available over the counter and can be a good option if you prefer not to rub on a cream multiple times a day. They’re particularly helpful for people who want steady, all-day relief from a single application.
What About CBD Creams?
CBD topicals are widely marketed for arthritis, but the evidence is thin. A few small trials found that transdermal CBD improved hand pain from arthritis, while another trial found no significant benefit. The Arthritis Foundation notes that many CBD products also contain menthol, capsaicin, or camphor, making it hard to tell whether the CBD itself is doing anything. It’s also unclear whether CBD in a cream or lotion actually penetrates deep enough below the skin to reach joint tissue.
If you’ve tried a CBD product and feel it helps, the relief may be real, but it could also be coming from the other active ingredients in the formula. At this point, doctors don’t have enough data to recommend CBD topicals over the better-studied options.
Which Joints Respond Best
Topical creams and gels work best on joints that sit close to the skin’s surface. Hands and knees are the two areas with the strongest evidence, and those are the joints most topical products are specifically approved to treat. Ankles, feet, wrists, and elbows also respond well.
Hips, shoulders, and the spine are a different story. These joints are buried under thick layers of muscle and tissue, and topical medications simply can’t penetrate deeply enough to reach them in meaningful concentrations. If your arthritis is primarily in those areas, oral medications or other treatments will likely serve you better than anything you rub on the skin.
Choosing the Right Option for You
- For the strongest overall relief: Diclofenac gel (Voltaren) is the best-supported choice. It reduces both pain and inflammation and has the most clinical evidence behind it.
- For people who can’t use NSAIDs: Capsaicin cream offers a non-NSAID alternative, though it requires patience through the initial burning phase.
- For quick, temporary relief during flare-ups: Menthol or methyl salicylate products (Icy Hot, Bengay) work fast but wear off relatively quickly.
- For convenience and steady relief: Lidocaine patches provide all-day numbing from a single application.
- For combination use: Capsaicin and menthol products work through different mechanisms than diclofenac, so some people layer them for broader relief. Check with a pharmacist before combining products.
No topical cream eliminates arthritis pain entirely. Most people find the best results by combining a topical treatment with other strategies like exercise, weight management, and physical therapy. But for accessible joints like the hands and knees, a well-chosen topical cream can meaningfully reduce daily pain with minimal side effects compared to pills.