Best Topical Pain Relievers for Quick and Safe Pain Management

In traditional medicine, there are primarily two types of pain relievers: oral medications and injections. However, topical pain relievers, which are rubbed on the skin, are becoming more prevalent due to their safety, efficacy, and ease of use.

Topical gels and creams are becoming a popular option for managing localized pain, offering a non-invasive alternative to oral or injected medications. Emerging research highlights their potential benefits, including fewer systemic side effects when used as directed.

This article discusses the science behind topical medications, their benefits, and side effects.

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Understanding Topical Pain Relievers

Topical pain relievers, also called analgesics, are precisely what the name implies: they are pain relievers in a gel, lotion, patch, or spray applied directly to the skin to relieve pain.

Some of the original, and still often used, topical pain relievers were ice and heat. Ice to numb and reduce swelling, and heat to relax muscles and fascia.

Modern topical pain relievers may include pharmaceutical and nonpharmaceutical ingredients, such as:

Lidocaine
Menthol
Methyl Salicylate (commonly derived from evergreen oil)
Camphor
Salicylates (found in aspirin)
Capsaicin

While not all non-pharmaceutical ingredients require FDA approval, consumers need to review product labels and consult with healthcare providers about ingredient safety.

How Do Topical Pain Relievers Work?

Oral medications pass through the gut and block prostaglandins, chemicals responsible for inflammation and pain. Some also block signals in the central nervous system that the brain interprets as pain. Research suggests that oral analgesics may be associated with gastrointestinal side effects, and topical options might provide an alternative for some individuals.

Topical pain relievers, on the other hand, interact directly with nerve endings in the skin to stop the pain signal sent to the brain. This is done through various mechanisms, including:

Counter-Irritation, also known as the Rubefacient Effect, causes redness and irritation which acts as a counter-irritant for the brain to focus on instead of deeper pain. This is seen in methyl salicylate.
Nerve Desensitization involves stimulating nerve endings to create a burning (capsaicin) or cooling (menthol) sensation that distracts the brain from more intense pain.
Local Anesthetic Action in medications such as Lidocaine directly blocks nerve signals at the site of application, resulting in numbness and lack of pain signals to the brain.

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Benefits of Topical Pain Relievers

There are many advantages to topical analgesics, including a lack of systemic side effects that occur when ingesting any oral medication. Research has shown decreased side effects when using a topical versus oral pain reliever.

Potential benefits include:

Targeted Relief: Topical pain relievers are applied directly to the skin, allowing localized application to specific areas such as the knees or hands.
Non-Invasive: Unlike oral medications or injections, topical formulations are non-invasive.
Versatility: Topical analgesics may be used for various types of pain, including acute and chronic conditions, as recommended by a healthcare provider.
Reduced Systemic Side Effects: While not free from risks, topical analgesics typically produce fewer systemic side effects compared to oral medications when used as directed.

Topical pain relievers can also be used for a wide variety of pains, including acute and chronic pain. Since they are rubbed into the painful area, a topical analgesic can be particularly useful for common areas of muscular pain as they also involve massaging the painful area.

Acute pain can be treated with diclofenac gel, ketoprofen gel, ice, and heat. These common injuries include:

Sprains
Strains
Bruises
Insect Stings

Chronic pain can also be treated with diclofenac gel, capsaicin creams, and lidocaine patches. These are useful for:

Types of Topical Pain Relievers

In addition to the type of pain reliever used, topical analgesics come in creams, gels, sprays, or patches. Each has its own pros and cons.

Creams can be easier to spread on the skin and can generally be applied to a larger area. However, creams may not be as effective for pain relief.
Gels, while often described as slick, have a thinner consistency and can better absorb into the skin. Research has shown this makes them more effective as pain relievers.
Sprays can easily cover a much larger area, but this also means a generally thinner layer with less efficacy than other methods of application.
Pain patches, also called plasters, are generally good for extended periods of pain relief. While a cream may only last for two-to-three hours, a patch will slowly release a steady amount of pain reliever and can last for 12 hours.

Natural ingredient-based topical analgesics, such as those containing eucalyptus oil, arnica oil, or cannabidiol (CBD), are gaining popularity. However, these products may not have FDA approval, and their safety profiles and efficacy can vary.

These ingredients can be found in Traditional Chinese Medicines such as Dit Da Jow. Common natural analgesics are:

Medical Insights and Safety

Numerous articles have been published on clinical use and safety of topical pain relievers. They have been investigated for use in chronic pain, sports injuries, and daily muscular and joint pain.

However, as with any pain reliever, there are potential side effects that a patient should discuss with their healthcare team. In 2024, the FDA issued warnings to consumers regarding certain over-the-counter topical pain relievers that made unverified claims or were deemed unsafe.

While the FDA has approved many topical analgesics, however in 2020, they suggested patients:

Do not use OTC products with more than 4% lidocaine.
Do not apply OTC pain relief products to irritated or broken skin.
Do not wrap your skin or treat it with topical analgesics with plastic wrap or other dressings, as this can increase the chance of serious side effects.

Common side effects of topical pain relievers include:

Skin irritation
Allergic dermatitis
Redness
Itching
Flaking skin
Swelling

Follow package instructions and avoid using on broken or irritated skin unless directed by a physician. Individuals should discontinue use and consult their healthcare provider if they experience adverse reactions after using a topical pain reliever.

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Key Takeaways

Topical pain relievers may provide a safe and effective option for managing localized acute or chronic pain with fewer systemic side effects compared to oral or injected medications.

Topical pain relievers are applied directly to the skin to target localized pain. They offer an alternative to oral medications with fewer systemic side effects.
Common active ingredients include lidocaine, menthol, capsaicin, and salicylates, each working through mechanisms like nerve desensitization or counter-irritation.
Topical formulations come in various forms, such as creams, gels, sprays, and patches, each with unique advantages and limitations depending on the area and type of pain.
While generally considered safe, patients should be aware of potential side effects, including skin irritation, redness, and allergic reactions, and follow recommended usage guidelines.
The FDA has issued warnings about some over-the-counter products making unverified claims; it's crucial to choose FDA-approved products when available and consult healthcare professionals for advice.
Topical analgesics are effective for acute pain (e.g., sprains, insect stings) and chronic conditions (e.g., arthritis, back pain), offering targeted relief.
Natural ingredient-based topical products, such as those containing CBD, arnica oil, or eucalyptus oil, are gaining popularity. However, these products may lack FDA approval, and consumers should consult their healthcare provider before use.
Proper usage includes avoiding application on broken or irritated skin, not using excessive amounts, and avoiding occlusive dressings to minimize risks.

As with any treatment, patients should consult their healthcare teams before using topical analgesics. Make sure to look for FDA approval of medicated treatments. Remember that some treatments will claim relief, but these claims have not been FDA-approved. Patients should try a small amount first to avoid any serious reactions.