[barb02]

It was suggested at the ms forum that I try this site. I have ms and arthritis. I was recently prescribed voltaren gel to use on my knees as I have had a problem with other nsaids causing stomach issues. I am relunctant to use this as I have a past history (about 10 years ago) of ulcers and I take nexium daily for GERD. I used it once on Thursday and became mildly nauseated about 6 hours later. MY pcp said that it should not be caused by the gel. I am supposed to use it 4x per day, but I only used it once yesterday as I an still experiencing nausea. She said I probably have a stomach virus that is going around. I think I am going to stop using it, and once the nausea has completely disappeared I will wait a few days and then try it again.

[jess18]

Hi,
I have used this, as I have GI issues and the NSaids were just irritating my stomach. It takes a little getting used to, and you dont want to use to o much. It is just supposed to not have the GI side effects and works directly on the joints. i used it when my dr thought I had tendinitis, and it does help, so give it one more try and if you cant tolerate.. then see other alternatives. good luck with it.

[mrsD]

This is an interesting question... so I searched the literature...
and by golly, nausea is reported for the topical use of Voltaren (diclofenac).
I don't know why this is...perhaps something to do with the gel vehicle?
One factor is lipofilicity of the drug. NSAIDs vary in how fat soluble they are.
When used topically the agent is chosen which has a high degree of fat solubility, and this unfortunately also includes the brain. I would wonder if you get blurred vision too?
I used to use Orudis for my knee and it was the strongest NSAID at the time, but also very lipofilic and I had terrible blurred vision from it. That is all I can think that would link to nausea. I think in your case the nausea is centrally mediated in the brain.

Expert Opin Pharmacother. 2008 Nov;9(16):2921-9.Click here to read Links
Topical diclofenac: clinical effectiveness and current uses in osteoarthritis of the knee and soft tissue injuries.
Banning M.

Brunel University, School of Health and Social Care, Uxbridge, Middlesex, UB8 3PH, UK. maggi.banning@brunel.ac.uk

BACKGROUND: Diclofenac is a commonly used non-steroidal anti-inflammatory drug (NSAID) for symptom control in osteoarthritis (OA) of the knee and soft tissue injuries. Although treatment with oral diclofenac is associated with serious adverse effects involving both the gastrointestinal and renal systems, these adverse effects are thought to be limited with topical diclofenac formulations without loss of efficacy. OBJECTIVE: The aim of this review is to explore the available evidence in relation to the pharmacokinetics, efficacy and reported adverse effects of the topical diclofenac formulations available. RESULTS/CONCLUSIONS: In the majority of studies examined, topical diclofenac formulations with sodium lotion, lecithin or epolamine gel, patch or plaster were either superior or equivalent to oral diclofenac formulations or placebo. Topical diclofenac significantly reduced pain and morning stiffness and improved physical function and patient global assessment without major adverse effects reported in patients with OA of the knee; and provided significant pain relief in patients with sports and soft tissue injuries involving the ankle, knee or shoulder. In the majority of studies, the predominant adverse effect involved pruritus or rash at the site of application, or nausea. The principle outcome of these studies is that topical diclofenac is a safe and practical alternative as a method of treatment in OA of the knee or as an alternative treatment for sports and soft tissue injury.

PMID: 18937623 [PubMed - indexed for MEDLINE

from http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

I will add that chronic GERD, may indicate that you are low in essential fatty acids in your diet. This food source keeps the mucus membranes and skin of your body flexible and healthy.
When very low, in Omega-3s, the lining of the stomach, esophagus and lungs are not repaired or maintained properly.
I have thread on this at the Vitamin forum:
http://neurotalk.psychcentral.com/showthread.php?t=6092

GERD is a modern "disease" ... it did not exist 20 yrs ago.
Long term use of drugs like Nexium and other acid blocking drugs eventually causes deficiencies in several nutrients that require acid to be absorbed and used normally by the body.
B12
folic acid
calcium
magnesium
iron
zinc
all can be effected/reduced and lead to neuro symptoms,
osteoporosis, and cardiovascular diseases.

The addition of EFA (essential fatty acids like flax oil, and fish oil) to the diet does wonders for GERD. It totally cured mine a decade ago.

There is another intervention for knee pain, that is not an NSAID. It is Lidoderm patches.
These have been tested against Celebrex and found as good for pain.
http://www.scienceblog.com/community...00512650.shtml
I prefer this way myself, and have used them for years now, intermittently.

For minor joint pain, I use OTC Salonpas. No side effects with these.
http://www.salonpas.us/salonpas.php
The ones with methyl salicylate in them 6% are the best ones to use for arthritis IMO. They have a new one that is 10%, but I haven't needed to try that one yet. It was just approved by the FDA (the first OTC pain patch ever approved). But they cost more money, because of that.