Do you combine oral and topical NSAIDs for pain relief?

This is a challenging situation but a clinical scenario frequently faced by a practicing rheumatologist. Topical NSAIDs rarely achieve a measurable blood level, and frequently can provide good pain relief at the site of symptoms. It can be a useful way to reduce the milligram dose of an oral NSAID, so it is reasonable to try. I do know any studies looking at this issue, however. I have successfully used this combination tactic with patients. More useful, though, is to combine topical NSAIDs with...

When topical NSAIDSs suffice we can decrease or possibly eliminate the oral NSAIDs thereby significantly reducing the likelihood of NSAID toxicities, especially a problem in our older patients many of whom have OA. So, yes, I usually recommend topical NSAIDs and encourage the tapering of oral agents.