Voltaren vs Biofreeze vs Lidocaine: Which Topical Pain Reliever Should You Use?

Voltaren vs Biofreeze vs Lidocaine at a Glance

Doses above are from the current U.S. Drug Facts or prescribing labels listed in Sources. Always follow the label on the package you buy, because store brands and formulations differ.

Three Different Mechanisms

Diclofenac is absorbed through the skin into the underlying joint and tissue, where it blocks cyclooxygenase enzymes and lowers prostaglandins that drive inflammation and pain. It treats the arthritis process locally, which is why it takes days to reach full effect. See Voltaren gel vs Advil.

Menthol activates TRPM8, the skin’s cold-sensing receptor. The cooling sensation competes with pain signals (the “gate” effect), so it feels better quickly, but it doesn’t change inflammation. Camphor and methyl salicylate products (Bengay, Icy Hot) work similarly; note methyl salicylate is a salicylate.

Lidocaine blocks sodium channels in nerve endings so they fire less. OTC products contain up to 4%; 5% lidocaine patches are prescription (FDA-approved for post-shingles nerve pain).

What the Evidence Says

• Knee and hand osteoarthritis: Topical NSAIDs are strongly recommended for knee osteoarthritis in the 2019 ACR/Arthritis Foundation guideline, and a Cochrane review found topical diclofenac provides meaningful relief. Menthol and lidocaine have little high-quality arthritis evidence.
• Acute strains and sprains: Cochrane reviews support topical NSAIDs for acute musculoskeletal pain, but the OTC Voltaren Arthritis Pain label says it hasn’t been shown to work for strains and sprains. Menthol products are labeled for these; trials are small.
• Low back pain: Evidence for topical products is limited. Heat wraps, staying active and oral NSAIDs have more support; menthol or lidocaine can be a reasonable short-term add-on.
• Nerve pain: Prescription 5% lidocaine patches help post-herpetic neuralgia; OTC 4% may help localized nerve pain for some people.

Using Them Safely

• Apply only to intact skin. Don’t use on wounds, irritated or damaged skin.
• No heat: Don’t use with heating pads, and don’t bandage tightly. Heat increases absorption, and there are FDA reports of serious burns from OTC counterirritant products.
• Wash hands after use and keep away from eyes and mucous membranes.
• Don’t layer products on the same spot. Voltaren’s label specifically says don’t apply other products to the same area.
• Don’t use lidocaine in large quantities or over large areas; too much absorbed lidocaine can cause dizziness, confusion or heart rhythm problems.
• Voltaren carries NSAID warnings (stomach bleeding, heart attack and stroke) and should not be combined with oral NSAIDs without a doctor’s advice.

Can You Combine Them?

Using different products on different body areas is generally fine. On the same area, don’t stack them; labels for Voltaren and many lidocaine products advise against applying other products there. Some products combine lidocaine and menthol in one patch. If you need relief in multiple places, ask a pharmacist rather than layering.

Topical vs Oral NSAIDs

The main reason clinicians reach for diclofenac gel before pills is lower whole-body exposure. The prescribing information for diclofenac sodium 1% gel reports that systemic exposure with recommended use is a small fraction of that from oral diclofenac, which is why topical NSAIDs are a preferred first option for knee and hand osteoarthritis in the 2019 American College of Rheumatology/Arthritis Foundation guideline, particularly for older adults and people at higher risk of stomach or kidney problems. Lower exposure is not zero exposure: the OTC label still carries NSAID warnings about stomach bleeding, heart attack and stroke, and says not to use it with other NSAIDs unless a doctor tells you to.

Don’t Add Heat or Tight Wraps

In 2012 the FDA warned about rare but serious skin burns, some second- and third-degree, after using OTC muscle and joint pain relievers containing menthol, methyl salicylate or capsaicin, (menthol is Biofreeze’s active ingredient). Most of the severe burns involved products with more than 3% menthol, alone or with more than 10% methyl salicylate, and many occurred after a single application. The FDA’s advice: don’t apply these products to damaged or irritated skin, don’t bandage tightly or apply heat, and stop and seek care if you notice pain, swelling or blistering where you applied it. Lidocaine patches carry similar instructions not to use with heat.

When a Topical Isn’t the Right Tool

• Back pain: The Voltaren OTC label is for arthritis pain in the hands, wrists, elbows, knees, ankles and feet; it is not labeled for back, hip or shoulder pain.
• New swelling, redness or heat in a joint, fever, or pain after a fall can indicate infection, gout or a fracture and need evaluation rather than self-treatment.
• Nerve pain (burning, shooting, numbness) is treated differently; prescription lidocaine 5% patches are FDA-approved for post-shingles nerve pain.

Who Should Choose What

• Arthritis in a knee, hand, wrist, elbow, ankle or foot: Voltaren, used 4 times a day for at least a week.
• Sore back, strain, bruise, quick relief needed: Biofreeze or another menthol product.
• Localized sharp or burning pain: lidocaine 4% cream or patch.
• Can’t take NSAIDs (ulcers, kidney disease, NSAID allergy): menthol or lidocaine.
• Pregnant 20+ weeks: avoid Voltaren unless a doctor directs; ask about the others.

Also comparing: Tylenol vs Advil and Aleve vs Advil.

When to Talk to Your Doctor or Pharmacist

• Pain lasts more than 7 days (21 days for Voltaren), worsens, or keeps returning.
• Redness, swelling, warmth, fever, or you can’t bear weight after an injury.
• Blistering, severe burning or skin damage where you applied a product.
• Numbness, weakness, or pain radiating down a leg or arm.
• You have heart, kidney or stomach problems, or are pregnant, before using Voltaren.

Frequently Asked Questions

Sources

• DailyMed: Voltaren Arthritis Pain (diclofenac sodium topical gel 1%) Drug Facts label
• DailyMed: Biofreeze Professional (menthol 13%) spray Drug Facts label
• DailyMed: Aspercreme Lidocaine (lidocaine HCl 4%) Drug Facts label
• PubMed: Kolasinski et al., 2019 ACR/Arthritis Foundation osteoarthritis guideline
• PubMed: Derry et al., topical NSAIDs for acute musculoskeletal pain in adults (Cochrane)
• PubMed: topical menthol analgesic randomized trial
• MedlinePlus: Lidocaine transdermal patch
• PubMed: Kolasinski et al., 2019 ACR/Arthritis Foundation guideline for osteoarthritis of the hand, hip and knee
• FDA Drug Safety Communication (Sept 2012): rare cases of serious burns with OTC topical muscle and joint pain relievers (official Spanish-language FDA page)
• DailyMed: Diclofenac sodium topical gel 1% prescribing information

Related Comparisons

• Voltaren Gel vs Advil
• Tylenol vs Advil
• Aleve vs Advil
• Aspirin vs Ibuprofen
• All Medicines Comparisons