What do topical pain relievers do?

A few weeks ago I posted about how to save money on oral over-the-counter pain relievers, such as acetaminophen and ibuprofen.

Then I decided to look into topical pain relievers. This post provides an overview of what’s available, and how to choose the right one and save money.

I was totally surprised at the scope of products available online and at the drugstore! I found a wide variety of ingredients (or combinations of ingredients) marketed for all types of pain. Even one product line could come in multiple forms: cream, ointment, spray, foam, stick, gel, patch…wow. How does an average consumer figure it out?

Topical pain relievers are marketed to provide relief for muscle pain, arthritis, burns, sunburns, sore throats, tooth aches, canker sores, and minor cuts and scrapes.

Choosing the best products depend on what kind of pain you need to treat.

As always, I advise knowing the different ingredients and what they do (and how well they do it). Then read the labels and pick the product that has the ingredient(s) you want at the best price.

Whether you want a cream or spray or stick or whatever is more of a personal preference.

And all these topical pain relievers should only be used over the short-term. If you have pain that needs longer treatment, check with your health care provider first.

What are the best ingredients?

Anti-inflammatories

One of the best topical NSAIDs, diclofenac 1%, is only available by prescription. For a weaker (not as effective) anti-inflammatory, look for tolamine salicylate (Aspercreme) or methyl salicylate (Bengay). Salicylates are related to aspirin (acetyl salicylic acid), so avoid these products if you’re allergic to aspirin or use other blood thinners.

Anti-inflammatory creams, gels or ointments may help minor arthritis pain or stress injuries in superficial joints. The medication isn’t well absorbed through thick layers of muscle, however, so it isn’t going to help a shoulder injury, for example. But inflammatory pain of the hands, feet or elbows may benefit.

Analgesics

Creams, gels and sprays that contain benzocaine (Orajel) or lidocaine (Solarcaine) actually numb the skin. Analgesics are commonly seen in products for oral pain (tooth aches and canker sores), sore throats, burns and sunburns.

They work, but only superficially and only for a short period of time (especially in the mouth because saliva dilutes it pretty quickly).

I once used an analgesic sore throat spray when I had the most horribly painful sore throat a few years ago. I also use an analgesic ointment for the occasional canker sore.

A concern with these topical analgesics is that they can cause increased irritation and discomfort, or an allergic reaction, which is why most health care providers don’t recommend them for burns or sunburns.

Counter-irritants

An interesting classification of topical pain relievers is “counter-irritants.” These include products with menthol and menthyl salicylate (Icy Hot), camphor (Campho-Phenique), and capsaicin (Zostrix).

They all increase blood flow to the affected area, and somehow reframe our perception of pain. Menthol and methyl salicylate produce a cooling sensation. Capsaicin produces a warm or burning sensation. Camphor may feel hot or cold, depending on the person. Many products contain combinations of these ingredients so they cover all the bases.

Counter-irritants are marketed for treating muscle and joint pain, and may provide a small amount of pain relief, or at least temporary distraction from the pain. Many people—myself included—find the smell of menthol and camphor overpowering. Personally, I’ve tried Bengay in the past and it did nothing for me, so I can’t really recommend these products.

Capsaicin (from hot chili peppers!), on the other hand, also hijacks nerve endings, so there is a real analgesic effect. The first few applications, however, might be painful.

Because counter-irritants are, well, irritating, precautions need to be taken when using them. Anyone with sensitive skin should avoid them. After application, wash your hands well and definitely don’t get any product in your eyes. (Have you ever rubbed your eyes after handling a chili pepper?).

And don’t wrap a tight bandage, such as an Ace wrap, over the medication. Also, don’t use it together with a heating pad. Either of these can exacerbate the burning effect and cause blistering.

Botanicals

Botanicals are extremely popular. Like most herbal remedies, these are not regulated by the FDA. The companies that make them don’t have to back up their marketing claims with any hard science, and their manufacturing standards aren’t overseen by any kind of authority.

In other words, buy and use at your own risk.

Related post: What’s in your supplement?

The most common botanical marketed for treating pain is arnica. It may come in a homeopathic preparation, which means there is only an extremely dilute amount of the active ingredient, or a more concentrated cream or salve.

Arnica is an herb long-associated with its healing properties. But because homeopathy is oddly based on the premise that less is more, only trace amounts of arnica will be in any of those products.

And while pure arnica may show promise in some studies for treating arthritis in the hands or knees, keep in mind that these over-the-counter products may not even list the actually amount of arnica in them. Hint: the further down the ingredient list you see arnica, the less there is.

Products I would use

I don’t like to clutter my medicine cabinet with expensive products that don’t work. In my opinion, that eliminates about 80% of stuff in most drug stores.

For minor pain and injuries, I usually use a combination of oral acetaminophen or ibuprofen, and either heat for muscle tension or ice for inflammation. Bruises, minor burns, cuts and scrapes don’t really benefit from topical treatments. Unless a sore throat is exceptionally severe, sipping liquids or sucking on a lozenge is treatment enough.

But the few topical products I think worth having around the house are:

I know aloe vera gel isn’t technically a topical pain reliever, but it can be soothing for a burn or sunburn, especially.

Related post: First aid for sunburns

Again, read the labels! Choose the product with the ingredient you want at the best price. And always read and follow the directions.

Sláinte,

Frugal Nurse

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