Understanding your options for topical pain relief - Mayo Clinic Press (2024)

Pain, muscle soreness and body aches can happen to the best of us — it‘s part of being human. But for people navigating chronic pain, it’s especially important to understand the full range of treatments and choose options that are safe for long-term or repeat use.

Topical treatments are an unsung hero when it comes to effective, cost-efficient and accessible pain relief. Just as the name implies, topical pain relievers are applied directly to the skin — say on a knee with arthritis or an old sports injury that’s acting up — and the medication is absorbed at the site of application, potentially soothing inflammation and discomfort.

“Topical pain medications can be used for many conditions, including muscle pain, osteoarthritis, and neuropathic, or nerve-related, pain,” says Jillian A. Maloney, M.D., a Mayo Clinic pain medicine expert.

These medications can be particularly beneficial, Dr. Maloney adds, because unlike other treatment options, topical medications don’t circulate throughout the entire body — they are concentrated on the site of pain. As a result, there are fewer side effects and medication interactions than with oral pain relievers. This can be especially important for older people and those with certain chronic conditions.

But topical creams have their limits. These treatments are great for “just under the skin” conditions such as arthritis, as well as knee and shoulder pain, according to Dr. Malone. “However, depth of penetration is an issue. Hip and low back pain coming from the hip joint or spine are difficult to treat with topicals.”

Below, Dr. Maloney discusses the different kinds of the topical pain relievers, including nonprescription and prescription options.

Options for topical pain medication

According to Dr. Maloney, there are two main groups of topical pain relievers — nonprescription and prescription-only products.

Though the goal of all these products is pain management, it’s important to consider your preferences when choosing a product. Some use the sensation of heat or cooling — or a combination of the two — to deliver relief, which some people enjoy and others may find too uncomfortable. Likewise, some products have a strong spiced or minty scent, while others have a mild fragrance. Consider also application — there are creams that look and feel like regular lotion, patches that prevent staining and can be worn under clothing, ointments, and spray bottles for easy application.

As far as cost, Dr. Maloney says nonprescription options are usually reasonable, ranging from about $15 to $25 depending on the type and size of the pain reliever. Prescription medications, on the other hand, can be expensive depending on which medications are recommended.

What are the different types of nonprescription topical pain medication?

The main categories of nonprescription topical pain medications include:

Nonsteroidal anti-inflammatory drugs (NSAIDs)

This is a group of drugs that can provide effective relief for general body pain, muscle sprains and strains, as well as symptoms of arthritis and osteoarthritis, such as inflammation, swelling, stiffness and joint pain. The most common type of topical NSAIDs is diclofenac, and it is available in patches, gels and creams. Though the exact dosage will vary based on the person and the strength of the medication, adults can apply 4 grams of 1% topical cream up to 4 times a day or use patches up to twice a day. However, after two weeks of use, Dr. Malone recommends speaking with your healthcare team about long-term use and any potential risks.

Lidocaine

“Lidocaine is a local anesthetic or numbing medication,” says Dr. Maloney. Nonprescription lidocaine patches are available up to 4% concentration. Prescription lidocaine comes in a 5% concentration patch. These patches help with nerve pain after shingles and chronic nerve pain after an injury or surgery. As an ointment or jelly, lidocaine can be used to relieve pain or itching associated with sunburns, insect bites or stings, minor burns, or reactions to poison ivy and poison oak. For pain and itching, lidocaine creams can be used up to four times a day in adults. Patches, meanwhile, can be used for up to 12 hours a day. As with NSAIDs, Dr. Malone recommends consulting with your healthcare team after two weeks of use.

Capsaicin

This is the component of chili peppers that makes your mouth burn — and it can be an effective treatment for nerve pain, rheumatoid arthritis and muscle pain. However, it’s important to note that some people avoid using capsaicin cream, as it can cause an uncomfortable burning sensation. The over-the-counter formulations are available in low concentrations, typically 0.025-0.075%. Look for generic options or brand names such as Caspin, Sportsmed, Therapatch Warm or Icy Hot Arthritis Therapy.

Counterirritant products.

These products provide a cooling, heating or itching sensation and provide relief for arthritis, simple backache, bruises, cramps, muscle strains and sprains. Menthol is frequently mixed with lidocaine and other pain medications in consumer products, according to Dr. Maloney. Products such as Icy Hot, Tiger Balm and Bangay use menthol — you will likely recognize the minty scent.

What are the different types of prescription topical pain medication?

Some treatments will combine multiple medications, such as ketamine, gabapentin, amitriptyline and other ingredients. These are referred to as compound medications, says Dr. Maloney, and are only available by prescription.

The main categories of prescription topical pain medications include:

Baclofen

“Historically, the muscle relaxant baclofen has been used orally for muscle rigidity in people with multiple sclerosis and spinal cord injuries,” says Dr. Maloney. However, when used topically, baclofen can be an effective treatment for nerve-related pain.

Capsaicin patch (Qutenza)

Available only through prescription, this is a high-concentration, 8% strength patch used for foot pain from diabetes and postherpetic neuralgia, or nerve pain caused by shingles. “The patch is applied by a healthcare professional with lidocaine gel to numb the skin, then the patch is removed after one hour for postherpetic neuralgia or 30 minutes for diabetic neuropathy,” says Dr. Maloney. This treatment can be applied every three months.

Gabapentin

“Gabapentin is known by many as a nerve pain medication,” says Dr. Maloney. “The oral medication has several side effects, such as dizziness, which are reduced or absent with topical gabapentin.” A few studies have shown it to be potentially useful for shingles pain and certain types of genital pain, specifically vulvodynia.

Ketamine

Ketamine has gained significant interest over the recent years for the treatment of pain and depression. Topical ketamine is most commonly used for nerve pain conditions like complex regional pain syndrome (CRPS), chemotherapy-induced neuropathy and postherpetic neuralgia. Unlike oral or intravenous versions that can cause altered perception or dizziness, topical ketamine does not cause significant side effects.

Are topical pain relievers worth a try?

If you’re experiencing pain — be it acute or chronic — topical pain relievers are worth a try, says Dr. Maloney. The type and concentration of medication, as well as pain severity and duration of treatment also can play a role in how effective topical pain relievers are. It may take a bit of trial and error to see what works best for you.

“Overall, topical analgesics are safe when used according to the package instructions or as prescribed. In general, these medications are well tolerated, with the most common side effects being skin irritation, rash or redness,” says Dr. Maloney.

If you’re unsure about your pain relief options — or want to talk about prescription treatments — consult with your healthcare team to determine the most effective options for you.