Topical Creams for Shoulder Pain: Diclofenac, Capsaicin, Menthol

Topical means "applied to the skin." Each of these creams works in a different way.

• Diclofenac is a non-steroidal anti-inflammatory drug, often called an NSAID. It is the same family of medicine as some oral painkillers, but less of it is generally absorbed when applied to the skin. It is sold in several countries as a gel or patch.
• Capsaicin comes from chilli peppers. It produces a warm or hot feeling and is thought to change how nerves send pain signals.
• Menthol creates a cooling sensation. It can make the skin feel different, which may distract from discomfort for a while.

A cooling or warming feeling is not the same as a change in the joint. Keep that in mind when you judge how well a cream is working.

There isn't strong research comparing these three creams for shoulder pain, so we cannot tell you which is most effective or how large any benefit would be. Here is the closest evidence, on the broader picture:

• Exercise has good support for rotator cuff-related shoulder pain. Progressive, resisted exercise probably helps, while gentle unloaded movement alone probably does not change pain much [R01].
• Most shoulder pain is managed in primary care with advice and exercise. NHS England now advises against routine scans unless there is a clear treatment pathway [R30].

A cream may offer short-term relief for some people. It is not a replacement for assessment or movement, and its effect on the shoulder itself is not established.

Creams are sold over the counter, which can make them feel harmless. Most people tolerate them well, but some safety points matter.

1. Follow the label. Use the amount and frequency stated on the packet, and do not apply more because it feels weak.
2. Check your medications. Ask your pharmacist before using an NSAID cream if you take blood thinners, other anti-inflammatory tablets, or have kidney, stomach or heart conditions.
3. Avoid broken or irritated skin. Do not apply to open wounds, rashes or sunburn.
4. Wash your hands after use. Keep the cream away from eyes and mucous membranes.
5. Be careful with heat-based creams. Capsaicin can cause burning. Do not use a heating pad over the cream, and wash off any that gets into the eyes.
6. Ask about allergies. Stop if you notice redness, itching, swelling or a rash.

1. Start with a clinician check. Especially if your shoulder is sore after a fall, has weakness or wakes you at night.
2. Ask a pharmacist. Bring your list of medications and ask which option, if any, is suitable for you.
3. Use a cream as a short extra, not the main plan. Give it a fair trial and note how your shoulder feels.
4. Keep moving gently. A seated routine, such as slow shoulder rolls or a gentle reach, can fit alongside a cream. Stop if pain increases.
5. Track your results. Write down your pain level and any side effects for two weeks, then review it with your clinician.
6. Think about sleep and posture too. Small changes to how you rest may help. See our guide to sleeping with shoulder pain.