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    Topical Therapeutics

    Topical Analgesics for Pain

    If You Have Persistent Pain, The Way to Lasting Relief may be Skin Deep

    If you’re suffering with acute or chronic pain, chances are you’re looking for pain relief so that you can return to your normal activities. In some cases, your doctor may prescribe oral and/or injectable medicines to help control your symptoms.  However, in some cases, the best solution may be in the form of medicines applied to the skin, called topical analgesics.  They have the potential to provide the same level of pain relief as oral and injectable analgesics, but often with several potential benefits, including fewer potential side effects (Argoff, 2013). Additionally, when used in conjunction with other alternative therapies, such as massage or physical therapy, there may be a compounded pain relief effect, making them an attractive pain relief option for those recovering from nagging injury.

    Not only are topical analgesics a valuable alternative for individuals looking to take control of their own pain, but some experts believe that they may also play an important role in the overall solution to the burgeoning opioid crisis in the United States, particularly since research has found that the use of topical analgesics may be associated with decreased need and use of oral pain medication, including opioids (Johnsen, 2017). 

    The Basics of Analgesics

    Topical Analgesics - the skin is an often under-utilized avenue for relief

    Analgesics, commonly referred to as painkillers, are medications that are used to decrease pain. There are different routes of administration including oral (by mouth), injection (intramuscular, intravenous, or subcutaneous), and topical (through the skin).

    History of Topical Therapies

    While the popularity of topical therapeutics has been increasing in recent years, they have been used throughout history. Prior to modern medical dominance of oral medications, various topical agents including salves, mud-based emollients, cold therapies, and other natural products were used for pain relief (Amstein, 2013). With recent advancements in science and technology, the physiology and pathophysiology of pain has become better understood, which has led to the development of more effective topical analgesics. This has allowed patients to take control of their pain with products that are readily available, relatively safe, and effective (Amstein, 2013).

    Type of Topical Therapeutics

    Topical analgesics describe a group of products that are applied to, or around, a painful area including topical pain cream, liquids, powders, gels, emulsions, semisolids, foams, patches, and aerosols that have pain-reducing, pain-blocking, and/or anti-inflammatory effects (Drapeau, McMahon & Crabb, 2018, Jorge, Feres, & Teles, 2011, Terrie, 2010).  Some topicals include additives to help reduce drug concentration, increase absorption, maintain the active component at the target area, in addition to providing less toxicity, less clearance, and an increased analgesic effect (Jorge, Feres, & Teles, 2011).

    While all topical analgesics have been designed to at least temporarily alleviate pain and promote comfort, different products contain different active ingredients. The most common ingredients found in over-the-counter topical analgesics include:

    • Capsaicin – this is the main ingredient found in hot chili peppers (Drapeau, McMahon & Crabb, 2018). It is sometimes recommended for chronic joint pain and diabetic nerve pain. After application, capsaicin serves as an irritant to local nerves, creating a warming, tingling sensation, which is expected to diminish over time. This warming sensation serves to essentially “mask” discomfort in the area. While Capsaicin has been shown to offer some transient relief to those suffering from certain types of pain (e.g. neuropathy), many people find capsaicin to be irritating and too bothersome to tolerate.
    • Salicylates (methyl salicylate; trolamine salicylate) – Salicylates fall into a family of drugs called non-steroidal anti-inflammatory drugs (NSAIDs). This anti-inflammatory ingredient is related to aspirin. Salicylate interferes with the production of prostaglandins, an inflammatory chemical produced where the body is injured. Individuals that have sensitivity to aspirin, and those that are taking blood thinners, should avoid topical agents that contain salicylate.
    • Lidocaine – is an anesthetic that provides pain relief by numbing the nerve endings by blocking nerve impulses that lead to pain sensation. Lidocaine injections have a variety of medical uses to temporarily block transmission in pain nerves; however, Lidocaine has no lasting analgesic or anti-inflammatory benefit.
    • Counterirritants – strong smelling products such as menthol, evergreen, camphor, and methylsalicylate are classified as counterirritants as they create a cooling or burning sensation on the skin that acts to temporarily distract the brain from pain in the area where they are applied. These agents have no anti-inflammatory properties and do not affect transmission of signals in pain fibers.  

    Benefits of Topical Therapeutics

    In addition to the pain relieving benefits of topical therapeutics, they are available without a prescription, easy to apply, and provide direct access to the targeted area, potentially providing faster pain relief by avoiding digestion and circulation (Drapeau, McMahon & Crabb, 2018). This is particularly beneficial in the case of musculoskeletal pain when pain is typically localized over a specific joint or area of the body. 

    Perhaps the biggest benefit of topical therapeutics is that they are associated with fewer potential side effects compared to oral or intravenous medications because they do not need to be digested and circulated (metabolized) by the body for their effect. This dramatically reduces potential damage to organs of the body. Further, topical analgesics provide pain relief with drastically lower risk of misuse, abuse, or addiction (Johnsen, 2017).

    Topical Therapeutics for Arthritis Relief

    Topical analgesics provide a unique treatment option for arthritis sufferers. According to the Arthritis Foundation, more than 50 million adults, and 300,000 children suffer from some type of arthritis (“What is Arthritis?, 2019). A systemic review of the literature investigating the effectiveness of topical analgesics in the management of acute and chronic pain conditions found strong evidence to support the use of topical agents for the treatment of chronic joint-related conditions, including osteoarthritis (Argoff, 2013).  

    This was further supported by results of a study published in theJournal of Pain Research that found that topical analgesics provide a safe and effective option for the treatment of moderately severe chronic pain that is associated with arthritis, as well as neuropathic and musculoskeletal disorders. Up to 54% of patients treated for a period of 3 months, and 60% of those treated for 6 months with topical analgesics decreased their use of concurrent pain medications (Johnsen, 2017).

    Conclusion

    There is mounting evidence to suggest that topical analgesics are a relatively safe and effective treatment option for acute and chronic pain conditions including arthritis and neuropathic pain, especially when used as part of a comprehensive approach to treatment (Amstein, 2013). If you’re suffering with acute or chronic pain symptoms that are interfering with your life, it may be time to try topical analgesics to get your symptoms under control and improve your quality of life.

     

    References

    Amstein, P.M. (2013). The Future of Topical Analgesics. Postgrad Med., Jul;125(4 Suppl 1), 34-41. 

    Argoff, C. (2013). Topical Analgesics in the Management of Acute and Chronic Pain. Mayo Clinic Proceedings, 88(2), 195-205. doi: 10.1016/j.mayocp.2012.11.015.

    de Falla, K. (2016). Uncommon Prescription Topical Analgesics for Arthritis Pain.

    Drapeau, S.J., McMahon, M., & Crabb, K. (2018). Topical Pain Medication to Treat Chronic Pain: An Alternative to Opioids.  

    Johnsen, M. (2017). Study: Topical analgesics may be one answer to the opioid crisis - Drug Store News. 

    Jorge, L.L., Feres, C.C., & Teles, VE.P. (2011). Topical preparations for pain relief: efficacy and patient adherence. Journal Of Pain Research, 11.  

    Terrie, Y. (2010). Understanding Topical Analgesics. 

    What Is Arthritis?. (2019).  

    What is the U.S. Opioid Epidemic?. (2019).  

    Keywords: Topical Pain Cream; Topical Analgesics