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Topical Analgesics: Pain Medications Applied Directly to Skin

Types of Topical Pain Medications, and How They Work

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Updated July 09, 2009

Topical analgesics are pain medications that are applied directly to the skin instead of being swallowed or injected. They may come in creams, lotions, gel or patch form. Topical pain medications work in different ways for different conditions, though they are commonly used to treat musculoskeletal pain and some types of neuropathic pain. While some may require a doctor’s prescription, many are available for over-the-counter purchase.

Types of Topical Analgesics

  • Counter-irritants. Topical pain medications that stimulate nerve endings when applied to the skin, and are used to treat musculoskeletal pain. Counter-irritants produce hot, cold or tingling sensations. These new sensations are thought to interfere with the sensation of pain.
  • Topical NSAIDs. These often contain aspirin, though other forms are available as well. Topical NSAIDs penetrate the tissues beneath the skin with anti-inflammatory medication, reducing swelling at the pain site. They also inhibit pain transmission from sensory nerves. These topical pain medications are used to treat musculoskeletal pain.
  • Capsaicin creams. Capsaicin comes from hot peppers, and works to inhibit pain transmissions from sensory nerves in the skin. This topical pain medication can be used for musculoskeletal pain or neuropathic pain.
  • Local anesthetics. Patch forms of local anesthetics can be applied to the skin, and may be worn for several hours for pain relief. These topical medications can relieve certain types of neuropathic pain.

Are Topical Analgesics Effective for Chronic Pain?

While chronic pain sufferers might find temporary relief with topical pain medications, many are not effective on their own for long-term pain management. So why use them? Well, for some people, topical pain medications offer tolerable pain relief with few side effects, something they may not get from other oral pain medications. They are also useful for people who do not tolerate typical painkillers well.

Topical creams like NSAIDs and counterirritants may also be used along with other medications to manage chronic musculoskeletal pain, such as arthritis. Local anesthetics may be used to manage breakthrough pain caused by nerve damage.

Potential Side Effects of Topical Analgesics

Because they are designed to act locally where the medication is directly applied, the levels of medicines are very low in the body's circulation. Therefore, topical pain medications rarely produce the same degree of side effects as pill forms of medication. They do, however, carry a risk of skin irritation or swelling. Once they are removed or washed away, the irritation usually goes away within a few hours. Symptoms may be worse if topical pain medications are applied in excess of instructions, or are left on the skin for longer than advised.

Sources:

American Chronic Pain Association. APCA Medications and Chronic Pain: Supplement 2007. Accessed 6/21/09. http://www.theacpa.org/documents/ACPA%20Meds%202007%20Final.pdf

Mason Lorna, Moore R Andrew, Edwards Jayne E, McQuay Henry J, Derry Sheena and Wiffen Philip J. Systematic Review of Efficacy of Topical Rubefacients Containing Salicylates for the Treatment of Acute and Chronic Pain. British Medical Journal. 2004 April 24; 328(7446):995

Mason L, Moore RA, Derry S, Edwards JE, McQuay HJ. Systematic Review of Topical Capsaicin for the Treatment of Chronic Pain. British Medical Journal. 2004 Apr 24;328(7446):991

Mason Lorna, Moore R Andrew, Edwards Jayne E, Derry Sheena and McQuay Henry J. Topical NSAIDs for Chronic Musculoskeletal Pain: Systematic Review and Meta-analysis. BMC Musculoskeletal Disorders. 2004; 5:28

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