Clearing's Chronic Pain Blog
2022 Guide to the Best Topical Pain Relief Treatments
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If you live with any kind of chronic pain, you’re probably no stranger to the wide world of pain relief ointments, sprays, and creams. These products, typically available over-the-counter, make hefty claims for how they can soothe and alleviate all manner of joint pain, back pain, arthritis pain and muscle soreness.
Some of these products actually have been shown to provide temporary relief for pain caused by certain conditions. Unfortunately though, not all live up to their promises. And with so many topical pain relief options to choose from, it’s easy to get lost in the sea of choices.
As if that wasn’t confusing enough, certain active ingredients are more effective for certain pain conditions, while others fall short. Plus, it’s not always immediately clear from reading a product’s label whether it will work for your unique needs.
Let’s take a look at what we know about some popular creams, sprays and ointments so you can get relief for your pain and soreness symptoms.
First, we explore the differences between creams, gels, ointments/balms, sprays and patches. While these pain-relief products may all seem to do the same thing, they actually do have significant differences in how they work and which ingredients they include.
5 main product categories for topical pain relief treatments
These products may remind you of your daily lotion or moisturizer. Creams are typically white or yellow, and have a thick, spreadable consistency. Pain relief creams will absorb into your skin after a few minutes, but they typically need to be rubbed into the affected muscle or joint to be fully absorbed. These products work well on joints that need to remain mobile, such as knees, shoulders, or elbows.
Gel pain relievers may contain higher amounts of certain active ingredients than a cream would. Muscle relief gels are typically oil-free, colorless and dissolve quickly into your skin wherever they are applied. Because of the properties of gel bases, they often produce a pleasant cooling sensation when applied to the skin.
Ointments and balms
An ointment or balm is intended to sit on the surface of your skin for longer than a gel or cream before it is absorbed. Typically, an ointment or balm tends to include more botanical or “natural” ingredients such as camphor, cinnamon and clove oil.
Pain relief sprays contain a wide variety of active ingredients. They are meant to be sprayed directly on your skin and can absorb nearly instantly. Pain relief sprays are meant to relieve itching, minor aches and muscle pains.
Pain relief patches can be applied directly to the area of your pain. These patches are meant to work for a longer period of time than a gel or cream product would, delivering a numbing or soothing agent to your skin continuously for several hours. These products work best on an area of skin with a flat surface, such as your neck or back.
How do pain relief creams relieve pain?
Most topical pain relief creams contain ingredients that work as “counter-irritants.” Basically, these ingredients distract your brain from the feeling of pain or soreness by introducing a different sensation on the same patch of skin.
Methyl salicylate (wintergreen oil) is a counter-irritant that creates a cooling sensation. Capsaicin, an ingredient found in chili peppers, is a counter-irritant that makes your skin feel warm. Creams marketed as “icy hot,” “cooling,” or “warming” may contain these active ingredients.
Another popular active ingredient is menthol (mint camphor). Menthol cools down your skin, which can make nerve endings feel less sensitive. This is similar to the way your skin reacts when you put an ice pack on an injury. For some people, menthol works to dial down down their pain level.
In addition to counter-irritants, topical pain relief creams may include a non-steroidal anti-inflammatory (NSAID) ingredient. Ibuprofen, indomethacin and diclofenac sodium are all ingredients that can reduce inflammation to help reduce your pain level. As a bonus, applying an NSAID pain reliever topically means that there’s a lower risk of certain side effects that can accompany popping a pain-relief pill, such as an upset stomach. However, many topicals that contain NSAID ingredients require a prescription.
A natural anti-inflammatory ingredient called arnica may be the main active ingredient in some “all-natural” creams and gels you want to try. Arnica comes from a large yellow flower known as wolf’s bane. It has been used for centuries as a natural botanical pain reliever and to treat swelling.
Lidocaine, a numbing agent, may also be included in pain relief creams and gels. Lidocaine can temporarily dull the feeling of pain by blocking the signals of nerve endings under your skin. Lidocaine is considered an anesthetic.
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What does the research say about topical pain relief creams?
It’s always a good idea to know what is in your pain relief products so you can determine why they might work for you. You can be your own best advocate when you’re armed with information about which ingredients have been proven to relieve pain for people like you. Some popular active ingredients for pain relief topicals have been well-studied in clinical research.
Here, we explore a few of the best-researched topicals:
Diclofenac and ketoprofen, both topical NSAIDs, have been shown to be effective to manage osteoarthritis knee pain when used regularly. If you are 75 years old or older or if you experience an upset stomach after using oral pain relief medication (like Advil or Tylenol), there may be another solution. Researchers (and the CDC) suggest that topical creams that contain NSAIDs might be the best first-line treatment available for chronic arthritis pain.
Herbal ingredients definitely should not be discounted when it comes to pain relief creams. Arnica gel has been found to reduce pain and improve hand function in studies of participants with osteoarthritis in the hands.
If your pain is localized to one region of your body — say, if you have chronic carpal tunnel pain or recurring pain deep in your shoulder muscle — there’s good reason to believe that a topical cream with menthol can provide temporary relief. In fact, menthol treatments have been shown to provide significant relief to both people with muscle strain as well as people with chronic carpal tunnel when compared to a placebo.
Topical capsaicin is recommended by the CDC for muscle pain and neuropathic pain. Research into the exact mechanism of how capsaicin treats pain is ongoing. As of now, the theory is that the ingredient causes a burning sensation which, over time, desensitizes pain receptors at your skin’s surface, followed by a period of pain relief.
When should I try a prescription pain relief cream?
Over-the-counter pain relief creams work for some people, but others find that they simply come up short. People with chronic pain may find that over-the-counter topicals aren’t strong enough to manage their symptoms. If this describes you, you may want to consider prescription-strength compound creams.
How are these different? Compound creams are individually-filled prescription topicals that are mixed together by a pharmacist. As the name suggests, the idea is that by blending a variety of ingredients into a customized formula, you’ll be able to get the maximum benefit of active ingredients that you know work for you.
This approach to topical pain relief creams is based in “rational polypharmacy.” This medical strategy requires a team of medical professionals who can address where your pain comes from and what tends to work for you. By targeting your pain with several different ingredients instead of just one or two, you might be more likely to find relief.
How effective is CBD topical pain cream?
Of course, we can’t address the success of botanical ingredients for pain relief without a note on CBD! Cannabidiol (CBD), a non-hallucinogenic ingredient found in the cannabis plant, is an emerging treatment for pain relief. Topical creams containing CBD are becoming more popular as new research illustrates how effective it may be for treating different types of pain.
Researchers still have more to learn about using CBD in pain relief creams, but the data so far is promising. A 2016 study found that a CBD cream absorbed through the skin decreased pain-related behaviors and inflammation in animal trials. In 2020, a small case series and literature review suggested that CBD cream was a significantly effective therapeutic treatment for managing chronic back pain.
A recent study examined the efficacy of topically delivered cannabidiol (CBD) oil in the management of neuropathic pain in a four-week, randomized and placebo controlled trial. There was a statistically significant decrease in multiple measures of neuropathic pain in the CBD group when compared with the placebo.
Why do some pain relief sprays and creams cause a burning sensation?
There are two likely reasons you may be experiencing a burning sensation from your topical pain reliever.
One is the ingredient capsaicin, which we’ve already mentioned. This ingredient, which is derived from hot chili peppers, creates a warming sensation on your skin that is meant to soothe and relieve pain. Some people have skin that is especially sensitive to capsaicin. If you have this sensitivity, it means that you’ll experience more burning and redness than other people might after applying a topical that contains it.
The second likely possibility is alcohol, as some pain-relieving topicals contain alcohol as a main ingredient. And, while alcohol absorbs quickly into your skin, it can have a very drying effect. In fact, some people feel their skin burning shortly after applying the product. Others may notice side effects of dry skin, such as flaking and redness, a few hours after the initial application.
What is the best topical pain reliever for treating pain?
For joint and muscle pain
If you’re looking to soothe muscle and joint pain, a cream with botanical ingredients that can soothe inflammation might be your best bet.
Based on available research, creams and gels that contain capsaicin, NSAIDs, lidocaine and menthol ingredients (in addition to other soothing botanicals) are the best topical options for treating muscle, nerve and joint pain.
These types of creams can address the pain signals happening in your tissues, creating a tingling, numbing sensation. At the same time, these creams can decrease inflammation and promote increased circulation to an area where a muscle may have been damaged or overworked.
The trade-off is that most creams and gels that contain these ingredients only work for short periods of time. They might temporarily address the pain that you feel, but with the exception of NSAIDs, they won’t work to heal an injury. However, patches that deliver the active ingredients for a significant span of time throughout the day may provide more relief over time.
If you’re treating chronic arthritis pain, a gel or patch that contains an anti-inflammatory pain reliever might be the way to go.
Arthritis pain is different from having sore muscles or nerve pain, and so it needs to be treated differently. You may be able to use a counter-irritant like menthol to help soothe and relax muscles that have been overworked, but that strategy probably won’t help you much when your elbow and knee joints are in pain from arthritis.
If you have chronic osteoarthritis pain, the American College of Rheumatology recommends using a pain-relief gel that contains a topical NSAID as one of the first lines of treatment. You may want to experiment with different doses and types of these products to find the one that works the best for you.
Are there people who shouldn’t use topical pain relief creams?
According to the doctors at the Cleveland Clinic, topical pain relief creams are safe for most people to use occasionally, but there are some precautions to consider.
Combining a topical pain relief cream with a heating pad might sound like a good idea. After all, self-applied heat therapy can soothe aching muscles and joints while the active ingredients in the topical do their magic. However, you should actually never mix a topical pain relief cream, especially one with an analgesic like diclofenac, with heat. Doing this can cause the active ingredients to absorb into your bloodstream at a faster rate than is advisable.
Rarely, people who use a topical pain reliever may experience a mild, temporary skin reaction that generally disappears in a couple of hours. People who have a history of heart conditions, kidney disease, or are pregnant or nursing should speak to their doctor before they start to use any type of topical pain reliever or new medication.
The bottom line
The best type of pain relief cream for you will depend on the symptoms of pain that you are treating.
Every person’s pain is different, and no two bodies are alike. If you’ve been trying different over-the-counter topicals for a while and can’t find relief for your pain, it might be time to speak with your doctor. A prescription-strength pain relief cream or other pain treatment options might be the next step in your treatment plan.
At Clearing, we support patients by providing pain-relieving solutions through a customized prescription compound cream and a personalized home exercise program, among many other care options. Learn more and get started today by clicking the button below.
If your skin has a rash or is damaged, a topical treatment may not be the best option. If you’re noticing redness, itchiness or breakouts while using the topical (or if it seems to be making you nauseated), let your medical team know and consider discontinuing the treatment. Finally, if the treatment isn’t giving you any relief after two weeks or so, it may not be the best fit for you.
Topical pain relief treatments do not generally contain addictive ingredients. However, it’s good to know what, exactly, is in your topical treatment, both to avoid an allergic response and to be sure about the potential for these ingredients to be addictive.
For some, an over the counter cream provides enough relief. For others, achieving relief requires powerful, customized pain-fighting ingredients that are more commonly found in prescription compound creams. If you’re not sure, discuss it with your doctor. Of course, factors like cost, insurance coverage and personal preferences also play a role. It’s good to keep in mind that if you have any characteristics you prefer in an OTC cream, such as a particular scent or degree of spreadability, your compounder may be able to replicate these qualities in a prescription cream.
This article is for informational purposes only and does not constitute professional medical advice. Always seek the advice of your healthcare professional with any questions or concerns you may have regarding your individual needs and medical conditions.