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How Do Topical Pain Killers Actually Work?

How Do Topical Pain Killers Actually Work?
How Do Topical Pain Killers Actually Work?

The Common Types Of Topical Pain Killers

Topical pain killers come in different forms they can be rub on, roll on, spray on liquids and creams as well as patches. There are a number of different options on the market that use different active ingredients the most common types of over the counter creams available without prescription are:

  • Counterirritants
  • Salicylates
  • Capsaicin
  • Non-steroidal anti-inflammatory

Counterirritants – Have ingredients such as menthol, methylsalicylate (oil of wintergreen), camphor, eucalyptus oil that makes the skin feel hot or cold and it’s thought that these creams distract your mind from the sensation of pain and this is what provides temporary pain relief.

  • Such as Deep Heat which contains methyl salicylate and menthol and Tiger Balm which contains the active ingredients camphor and menthol.

Salicylates – Active ingredient is the same as what gives aspirin its pain relieving quality. When they are absorbed into the skin they may help with pain particularly when the target area is close to the surface of the skin. Meaning areas such as the fingers, elbows and knees if any are most likely to have a positive effect with these creams.

  • Such as Aspercreme and Myoflex Cream which contain Trolamine Salicylate.

Capsaicin – Capsaicin is the main ingredient of hot chili peppers and is one of the most effective ingredients for topical pain relief. These creams cause a warm to hot, tingling or burning sensation. Capsaicin applied to the skin depletes a chemical (substance P) in nerve cells that helps send pain signals to the brain.

  • Such as Zostrix HP Cream which contains capsaicin and Glucosamine Rapid which contains glucosamine sulfate and capsicum.

Non-steroidal anti-inflammatory – These are topical substances that contain an anti-inflammatory medicine such as ibuprofen, diclofenac, felbinac, ketoprofen, or piroxicam and come in various different brand names. These creams work by blocking the effect of chemicals called cyclo-oxygenase (COX) enzymes. COX enzymes help to make other chemicals called prostaglandins. Some prostaglandins are involved in the production of pain and inflammation at sites of injury or damage. A as result a reduction in prostaglandin production reduces pain and inflammation.
Using a topical preparation means that the total amount of anti-inflammatory in your body is very low as a result you are much less likely to have a side-effect using topically than orally.

  • Such as Voltaren Emulgel which contains Diclofenac Diethylammonium Gel and Nurofen Gel which contains ibuprofen.

Do Topical Pain Killers Work?

There is little evidence to suggest they do. A systematic review in 2009 found little evidence that over the counter sports creams using salicylates have any effect at all on muscle aches and pain when compared with a placebo. Another comprehensive review of research on over the counter sports creams containing salicylates as the main active ingredient found them not to be effective however there is some evidence to suggest that topical local anesthetics, topical capsaicin, and some topical NSAIDs may reduce muscle pain from strains and sprains.

Are Topical Pain Killers Safe?

When used in accordance with the label directions over the counter topical pain killers are relatively safe, however they should not be used long term or in excessive quantities.
Side effects may include:

  • Burning
  • Stinging
  • Irritated skin

Never use these medications on broken or irritated skin and do not use heat on your injury if you have applied these topical medications as this can increase the risk of burns and always wash your hands thoroughly to avoid accidental ingestion or application to the eyes.  Creams containing salicylates should not be used by those who are allergic to aspirin and do not apply topical creams with methyl salicylate before you exercise because your body could wind up absorbing too much of the active ingredient as exercising may increase your circulation to this area.

Worth Noting: If you are not getting relief from the topical products you are using don’t simply use more, overdoing it could put you at a greater risk of burns and or allergic reactions.

Disclaimer: Always talk to your doctor prior to starting any medication and topical pain killers are no exception to this rule. Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance on How Do Topical Pain Killers Actually Work? should consult his or her general practitioner or physiotherapist.

Hayden Latimer is the founder of and principle physiotherapist at Sydney Physio Clinic. Since graduating from Otago University, Dunedin, New Zealand he’s gained wide experience practicing across the globe for over 15 years and is now extremely knowledgeable in helping people reduce discomfort and restore function and mobility.


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