I've tried Voltaren and generic diclofenac twice, in 2018 after I was hit by a car (broken and dislocated shoulder, re-injured neck which was first broken in 2001), and recently for recurring neck, shoulder and, now, new flareup of hip and quad pain. I can't say it has any effect at all on me. But my insurance covers a lot of OTC pharmacy stuff, including topical analgesics, so I might try it again.
In 2018 my problem was pain from a fresh injury, not inflammation, so I needed real pain meds, not anti-inflammatories. Unfortunately due to the opioid scare, health care practitioners are no longer honest about pain relief and are pressured to pretend that ibuprofen and acetaminophen do the same thing (they don't -- one is a mild anti-inflammatory, the other is a mild analgesic), and are adequate substitutes for Tramadol or hydrocodone (not even close).
Same reason they used to push gabapentin as a substitute for pain meds, despite research stating that it's only minimally useful for some types of neurological pain and there's no evidence that it's useful for migraine, pain due to injuries, arthritis, etc. And now some health care systems have begun to restrict gabapentin as an controlled substance. They can't practice medicine anymore using their own judgment due to pressure from the government and media hysteria.
I've had better and quicker -- albeit temporary -- results with Stopain roll-on and Ted's Pain Cream. Both contain MSM, among other common ingredients. But I suspect the skin sensation merely distracts us from the pain for 15 minutes to an hour at most.
The problem with topical analgesics is they cannot penetrate the skin barrier in healthy, unbroken skin. That's what skin does. That's why we can be exposed to or handle so many potentially hazardous materials with little or no effect, which might be harmful in contact with broken or compromised skin.
The exception may be topical analgesics that contain MSM (methylsulfonylmethane) or DMSO, which can penetrate the skin barrier. When I worked in health care as a lab tech back in the 1970s we used DMSO to prep human and animal tissues for research and preservation, and one trick we all tried at least once was to apply DMSO directly to the skin and see how long it took to detect a garlic taste in the mouth. Theoretically DMSO could be used to transport poisonous or toxic materials across the skin barrier, and I remember reading a fiction book about someone being killed with concentrated tobacco extract in a DMSO carrier, sprayed or doused on the victim. No idea whether that's actually possible, but it's likely the Spy vs. Spy guys in government and military agencies have tested it.
However for years DMSO has been readily available in farm and ranch supply stores, mostly as horse liniment, and became popular as a folk remedy for arthritis among rural folks. If DMSO was really dangerous we'd have heard more warnings and it would have been withdrawn from the market or regulated for safety. DMSO can cause skin irritation in sensitive people.
MSM is slightly less effective than DMSO as a skin barrier penetrant, but much less likely to cause skin irritation. It's a common carrier in many OTC topical analgesics. Check the label carefully because some major brands, such as Blue Emu, have MSM in *some* products but not all. Same with the overrated CBD and hemp topicals -- I've never found one that contains MSM.
I usually apply Stopain first to prime the skin, then Votaren or CBD (I usually prefer Lazarus Naturals high potency full spectrum, which contains a minimal amount of THC, the usual 0.3% that passes federal scrutiny and is somewhat effective for some people).
This helps a little on surface level pain: my neck where I have severe cervical spine stenosis and spondylosis; and arthritic wrists and thumb joints. It does nothing for deeper pain covered by muscle, and doesn't seem to help with muscle pain. Nothing has helped the deep pain in my left quad that resulted from running the past few years and suddenly worsened a few months ago.
The massage from applying topical analgesics probably helps as much as any ingredient in the topicals. I get about the same relief from my percussion massagers -- minimal and short-lived.
Here's why I'm skeptical about some topical analgesics, notably Voltaren/diclofenac, and even Ted's Pain Cream -- these all recommend repeated use, a few times a day, for two weeks or longer.
The problem with ascribing pain relief to that protocol is that it's akin to those folks remedies about curing the common cold -- vitamin C, zinc, chicken soup, whatever. The usual folk remedies claim that if you use these magical potions your cold will be over with in only 5-7 days. Otherwise, without treatment, it can drag on for a whole week!
If our localized pain is relieved after two weeks using Voltaren... maybe it was just time and rest that did the real work.
When I first tried Ted's Pain Cream back in 2018 or 2019, the directions specified that it should be applied a few times a day for about two weeks to evaluate any long-term relief. However, the difference is that the manufacturer specified that in his potion, it's the resveratrol doing the real work of "resetting" pain nerves that are stuck in pain mode long after an injury has healed. I liked the theory and tried it a few times.
But it's possible my neck and shoulder injury and pain are too severe for any topical analgesic to be effective. So I might not be the ideal candidate for these therapies.
Anyway, I've pretty much given up on topicals. I can't take ibuprofen or any NSAID daily -- after three days I develop psoriasis flareups, especially in my scalp, sometimes between my fingers. Recently it's worsened to the point that the psoriasis rash extends to my upper eyelids, dangerously close to my eyes. So I won't use NSAIDs again unless there's absolutely no alternative. I don't get that response to prednisone and for the past few years have needed prednisone or methylprednisolone once or twice a year for inflammation in my sinuses and joints. It works but screws up my endocrine system (I also have Hashimoto's thyroid disease and had thyroid cancer several years ago).
Acetaminophen kinda works for minor to moderate pain, but I've taken at least 500 of those damned things since last autumn -- that's when I bought a bottle of 500 capsules, which I just finished last week. That's a helluva lotta acetaminophen and if I live long enough it'll probably kill my kidneys. But we don't get many alternatives.
If acetaminophen doesn't work I'll used CBD or kratom. The latter two have been effective for me for the past five or six years. I still dislike taking them because they interfere with my normal energy level, but all pain management involves some compromise. On the plus side, CBD and kratom in reasonable doses don't appear to have any long-term negative consequences, although there isn't much long-term research to back up the anecdotes of folks who use these.
Personally I'd rather have Tramadol or hydrocodone, but in the current political and cultural climate asking for those is an invitation to be treated like a junkie.
I've also had injections in my neck for spondylosis and stenosis pain, but those barely had any effect. The doctor suggested a nerve block that basically zaps the nerve and supposedly works for a few months, but I'm not persuaded it'll work any better than the local analgesic injections which were given to test the efficacy and satisfy my insurance requirements. The only alternative is surgery to remove some bone in my spine to reduce pressure on the nerves, but they won't authorize that until it becomes bad enough to cause partial paralysis or incontinence.