Pills, injections, electrical stimulation, physical therapy, yoga, even surgery — there are an array of potential treatment approaches for people with chronic pain. One option, which some people find both relatively easy and convenient, is topical pain cream. 

Can spreading a simple-seeming cream prove effective though? In fact, pain creams transmit powerful pain-suppressing ingredients through the skin, where they can affect pain deeper in the muscles, nerves and joints. Though creams don’t work for everyone all the time, they often do help with even stubborn forms of pain. 

What are topical pain creams?

People have sought solutions for pain relief pretty much since the beginning of civilization. While many early remedies were meant to be drunk or swallowed, some were meant to smear over the skin. Prior to 200 AD, the Greek physician Galen was writing about “Olympic Victor’s Dark Ointment,” an opium-based salve developed for athletes. 

Certain familiar pain creams being used today, such as Bengay or Tiger Balm, date back more than 100 years. In the campaign to control pain, they are joined by today’s modern compounded creams, which use specialty ingredients in unique combinations to target persistent pain. 

Compounding is the pharmaceutical process of mixing different medications to target specific needs for specific patients. Compounded creams developed to address pain contain the ingredients and doses specialists recommend for each patient’s personal levels of pain.

Creams, which are usually light-colored and somewhat thick in consistency, work best when rubbed thoroughly into the skin. They are often meant to treat localized pain. For usability, creams are often recommended for parts of the body that move a lot, such as knees, elbows, wrists and hands. Though they may appear similar, not all pain creams are created equal. Quality, consistency, scientific grounding and usability set the top pain creams and their ingredients apart from the rest. 

How do pain creams work?

Creams developed to treat pain rely on a variety of strategies. These include: 

Controlling inflammation

Non-steroidal anti-inflammatory drugs (NSAIDs) address pain by calming irritated, inflamed body tissues while also lowering pain.

• Diclofenac is an NSAID often included in pain creams, particularly arthritis cream, where it targets joint inflammation.
• Ketoprofen and ibuprofen are examples of other NSAIDs sometimes added to pain creams.
• Salicylates use the same active ingredient as is found in Aspirin, which was originally derived from willow bark. 

Distracting pain pathways

Sometimes the body can be “distracted” or “confused” about sensing and reporting pain when alternate sensations are introduced. Pain creams employ this strategy by introducing ingredients that induce feelings of burning, chilliness, tingling or other unusual sensations. These are called counter irritants. 

• Camphor can reduce inflammation and numb the skin to reduce pain. It is often paired with ingredients that make the skin feel cool and chilled. Camphor shouldn’t be used in excess, and isn’t recommended in solutions of greater than 11 percent.
• Capsaicin, which comes from chili peppers, interferes with pain signaling pathways while producing a tingling, burning sensation. Diabetic nerve pain and joint pain often respond well to capsaicin, though it may take a few weeks to observe its full effects.
• Menthol restricts blood flow while making the skin feel cooler, which cuts down on the amount and intensity of sensations the nerve endings generally report. 
• Methyl salicylate (also called wintergreen oil) makes the skin feel cooler as well, and some people report feeling soothed by its minty smell.

Numbing or dulling

Certain ingredients act like a local anesthetic, dampening pain signals and preventing them from reaching the brain as effectively.

• Lidocaine acts as a local painkiller, numbing feelings of pain so they aren’t as bothersome.
• Tetracaine and benzocaine are alternate nerve blockers, which often work better when combined with lidocaine.
• Cannabinoids, such as those included in CBD creams, are increasingly used to address pain as well, though the products that contain them have not always been widely tested. 

Other strategies

Treating pain can be complex, and pain creams can incorporate more than one active ingredient to combine multiple ways to address pain. 

• Muscle relaxants like baclofen and cyclobenzaprine help muscles release some of the tension that can underlie pain. 
• Nerve blockers like amantadine and ketamine can alter how the nerves transmit and interpret pain signals.
• Calcium channel blockers like verapamil and nifedipine are sometimes included in specialty pain creams.

What are some of the top pain cream ingredients? 

Though many ingredients can be found in topical pain relief creams, not all ingredients or combinations of ingredients have been evaluated by the Food and Drug Administration (FDA) for safety and efficacy. When you pick a pain cream, then, it’s wise to do so with a pain specialist’s guidance. 

A 2020 consensus report by the National Academies of Sciences, Engineering and Medicine identified the following ingredients as being potentially most effective, based on clinical studies: 

• Diclofenac
• Lidocaine
• Naproxen

What else is in pain creams?

Creams don’t only contain active ingredients. Other ingredients are needed too, to form the base and help the cream absorb into the skin. Creams can contain vegetable oils, alcohols, glycerin, water and other stabilizers and fillers to make the cream spreadable and storable.

Compounders and cream designers may add certain scents or  “natural” painkillers and additional botanicals as well, since scent can play a role in pain management, and certain studies indicate a positive potential impact of using essential oils in aromatherapy as part of a pain management strategy. 

Below we list a few common pain cream inclusions:

• Lavender essential oils are sometimes included, as the scent can be quite soothing.
• Ginger, rosemary, eucalyptus, mint, calendula, chamomile and cinnamon oil and extracts are often used in pain creams as well.
• Arnica is derived from a flowering plant and can be added to creams and tinctures as a natural pain reliever. (It should not be swallowed.)
• St. John’s wort may be included in pain creams and is sometimes taken for depression and nerve pain, among other conditions. It’s good to be careful and to consult medical professionals when taking St. John’s wort, as it can interfere with many common medications.
• Cannabidiol (CBD) which is non-hallucinogenic, comes from the hemp plant and affects pain pathways in the body. Studies on its effectiveness are not yet complete, but initial results are encouraging when it comes to CBD’s potential to quell pain.
• Vitamin E may support other pain cream ingredients’ effectiveness and may reduce joint inflammation.

Hints for getting the most out of pain creams

• Check with your doctor or pain specialist before starting to use pain creams, as some ingredients may affect you, particularly your liver, or may interact with other medications you’re already taking.
• Look for FDA-approved ingredients. Ingredients that aren’t approved by the FDA may not exhibit consistent quality or effectiveness. Some non-regulated ingredients may not be safe for you.
• Don’t mix oral and topical NSAIDs. NSAIDs in pain creams may cause fewer side effects than those in oral NSAIDs, but it’s still possible to overdose on NSAIDs with either oral or topical medications, so it’s wise to be mindful of your doses.
• Creams may take a few weeks of application before you feel their full effects. If you notice itching or rashes when you use the cream, let your doctor know.
• Some creams may feel greasy at first. It’s a good idea to give them time to fully soak in before putting clothes on or moving around, for example. Some people use gloves for applying cream if they don’t want to get it on their hands.
• If you’re using a cream with tingling, burning or cooling properties, be very careful you don’t accidentally get any of it on sensitive areas, including your eyes and genitals (it may result in some surprising and not very pleasant sensations!)
• In the same vein, don’t mix heating pads and pain cream use, since heat may overly accelerate your body’s uptake of the cream’s active ingredients. 
• If you’re a swimmer, check to see what options you have in terms of waterproof creams or patches. It might also be possible to cover the area you rub cream on with protective plastic.

Not all pain relief creams work for all people. If your pain isn’t responding to the cream you chose, a different cream, a different topical treatment such as a topical spray or patch, or a different treatment approach altogether may serve you better.

How Clearing’s compounded cream may help

Clearing takes a personalized, “big picture view” when addressing pain. Its plans include personalized home exercises, access to advanced pain specialists and, if applicable, compounded creams that are not available over the counter. Clearing uses both diclofenac and lidocaine in its creams, as well as other FDA-approved ingredients, for maximal effectiveness. Clearing also offers nutraceuticals and CBD cream. Find our more today!