Topical pain medications are applied directly to the skin and come in a variety of forms including creams, gels lotions and patches. The three major categories of topical pain relievers are:
- Topical Analgesics Containing Salicylates
Salicylates (Methyl Salicylates), the same ingredients found in aspirin, are effective pain relievers that also reduce inflammation. However, researchers have found that salicylates do not ease muscle pain when used as a topical cream applied to the skin. Although this review of the literature was quite comprehensive, many athletes disagree with the findings and continue to use these popular over the counter creams.
These creams are not recommended for use by those who are allergic to aspirin, due to an association between the development of Reye's Syndrome and the use of aspirin (a salicylate compound). Brand name products include Bengay, Aspercreme and Sportscreme.
- Capsaicin Creams
Capsaicin is a compound found chili peppers that causes a hot, burning sensation. Capsaicin applied to the skin depletes a chemical (substance P) in nerve cells that helps send pain signals to the brain. Brand name products include ArthriCare, Capzasin and Zostrix.
These products contain ingredients such as menthol, wintergreen or eucalyptus oil that makes the skin feel hot or cold. It’s thought that this distraction from the sensation of pain is what provides temporary pain relief. Brand name products include Flexall 454, Icy Hot and JointFlex.
Do Topical Pain Relievers Work?
There is little evidence to conclusively show that these products work. In fact, one comprehensive review of the literature, published in the July 2009 Cochrane Database of Systematic Reviews, 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 (sham treatment).
According to Oxford biochemist Andrew Moore, who lead a comprehensive review of all studies on the topic, over the counter sports creams containing salicylates as the main active ingredient are not effective and are, in fact, a waste of money. He did report some evidence that topical local anesthetics, topical capsaicin, and some topical NSAIDs may reduce muscle pain from strains and sprains.
Are Topical Pain Relievers Safe?
When used moderately, and in accordance with the label directions, these topical medications are relatively safe. They should not be used long term or in excessive quantities. It’s also important to realize that many of these medications mask or suppress the natural pain signals of the body, and ignoring pain can increase your risk of further muscle or joint injury. If you do use these medications for temporary pain relief, it’s important to rest your sore muscles, so try to avoid intense exercise until soreness subsides.
Side effects from these medications often include burning, stinging or irritated skin. Never use these medications on broken or irritated skin. Do not heat or ice your injury if you are using these topical medications and always wash your hands thoroughly after applying creams, lotions or gels. As stated above, creams containing salicylates should not be used by those who are allergic to aspirin.
Topical Pain Relievers and Overdoes
While extremely rare, it is possible to overdose on these topical pain relievers. An overdose occurs when someone accidentally or intentionally uses more than the normal or recommended amount of this product.
Overdoses can be serious, and sometimes fatal. An excessive absorption of the chemical methyl salicylate can lead to toxic levels in the blood and cause the same symptoms as an overdose of aspirin (nausea, vomiting, sweating, rapid breathing, and ringing in the ears) and possibly death. In fact, in 2007 a 17-year-old high school track athlete died after accidentally overdosing on methyl salicylate.
Matthews P, et al. Topical rubefacients for acute and chronic pain in adults. Cochrane Database of Systematic Reviews. Issue 3, 2009. [http://www.cochrane.org/reviews/en/ab007403.html].
McCleane G. Topical application of doxepin hydrochloride, capsaicin and a combination of both produces analgesia in chronic human neuropathic pain: a randomized, double-blind, placebo-controlled study. British Journal of Clinical Pharmacology. 49.6 (2000):574-9.
National Institutes of Health, Medline Plus, Sports Cream Overdose.
National Institutes of Health, Medline Plus, Methyl Salicylate Overdose.