■ 15 – 20 minutes: The onset of anesthesia begins at this point. The feeling of numbness is starting to spread out in the target area.
■ 45 – 60 minutes: The anesthesia has infiltrated the entire target area. The loss of sensation in the superficial layer prevents any feeling of pain or discomfort. Quick and simple dermal procedures can be performed at this stage.
■ 60 – 90 minutes: The peak of anesthesia effect. In most cases, this is the best time to start a more complex dermal procedure because the efficacy is at its highest.
■ 90 – 120 minutes: The duration of maximum anesthesia effect is approximately sustained up to this point.
■ 120 – 180 minutes: The anesthesia effect will gradually diminish. Re-application is highly recommended for another extended period of time.
In studies lasting 6 to 12 weeks, topical diclofenac and topical ketoprofen were significantly more effective than carrier for reducing pain; about 60% of participants had much reduced pain. With topical diclofenac, the NNT for clinical success in six trials (2343 participants) was (95% confidence interval ( CI ) to 16) (moderate quality evidence). With topical ketoprofen, the NNT for clinical success in four trials (2573 participants) was ( to ) (moderate quality evidence). There was too little information for analysis of other individual topical NSAIDs compared with carrier. Few trials compared a topical NSAID to an oral NSAID , but overall they showed similar efficacy (low quality evidence). These efficacy results were almost completely derived from people with knee osteoarthritis.
Topical gels have been shown to reduce the need for oral analgesics which is a good thing for reducing side trial found that topical capsaicin reduce pain more than placebo in people with AS, although it can cause burning sensations. Another trial used a gel form of a drug called tenoxicam (an NSAID) that suggested it might be helpful. Do ask your specialist if you can try something like voltarol – or a stronger version on prescription – and follow their individual advice. They may prefer you to have some oral anti-inflammatory on board to reduce inflammation throughout the body, however.