How do Topical Pain Relievers Work?

Treating pain: it is one of the hottest topics in medicine over the last 20 years. With the potential side effects some patients experience while taking narcotics, NSAIDs, and other pain-relieving drugs orally, researchers continue to study ways to relieve pain safely and reliably. New and inventive solutions are opening up the scope of pain treatment and making it easier than ever to reduce pain without side effects. One of those solutions is topical pain relievers.

The Pain Treatment Problem

The biggest issue researchers face to date with pain relief is the fact that side effects seem to be intrinsically connected to efficacy. Some studies show that the euphoria experienced when taking opiates may be part of the reason narcotics are so effective at reducing pain. Other studies show that safer drugs just aren’t as effective as those with serious side effects, leaving physicians in a constant quandary about what to prescribe and when to tell the patient there are few options available to them.

How Topical Pain Relievers Help

Enter topical pain relievers. These medications, often compounded, are applied directly to the skin rather than entering the body through the stomach. In many cases, they’re an effective balm against everything from aches and pains to serious, intractable nerve pain. What makes topicals so unique is that many formulas never reach beyond the first few layers of skin and tissue, and thus, won’t enter the bloodstream, significantly reducing risks and side effects.

Treating Conditions Safely With Topicals

Topical pain relievers may reduce risks while treating problems almost as effectively for patients, especially those in sensitive populations. This burgeoning sector of the medical industry shows great promise. Researchers expect the list of topical treatments to grow exponentially over the next 10 to 20 years, but even today they’re of benefit to plenty of patients with conditions like arthritis, fibromyalgia, and everyday aches and pains.

Topical Pain Reliever Classifications

Topical pain relievers fall into specific classifications, each of which may or may not be suitable for treating your pain. These classifications include:

• Counterirritants
• Salicylates
• Capsaicin
• Steroid/corticosteroid drugs
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
• Local anesthetics and numbing agents

Counterirritants

Counterirritants produce mild irritation at the site of the pain. Though it may seem backward, “busying” the nerves locally reduces the intensity and frequency of pain signals to the brain. The nerves are too busy “reporting” on the sensation from the counterirritant to properly pass on more severe pain signals, reducing the overall sensation to a mild burning or stinging. The most common counterirritants include alcohol-based rubs like A535, Icy Hot, and mentholated Tiger Balm.

Salicylates

Salicylates contain a similar substance to aspirin, an NSAID drug. They may reduce inflammation and block localized prostaglandins near joints and soft tissue damage points. Unlike oral Aspirin, topical salicylates are much less likely to excessively thin the blood or cause stomach damage.

Capsaicin

Capsaicin-based topical pain relievers contain a substance derived from pepper; they produce a “hot” sensation that feels as if it penetrates deep into the tissue. They work in a similar way to counterirritants in that they keep local nerves busy and interrupt pain signals before they reach the brain. There’s also evidence that capsaicin creams may encourage better circulation to the area of an injury, speeding healing. The only caveat is that some patients do seem to react more strongly to topical capsaicin than others, especially if they have sensitive skin.

Steroid/Corticosteroid Drugs

Topical steroids and corticosteroids effectively reduce localized inflammation for many patients and are most commonly used to treat potentially painful skin conditions like psoriasis. If an autoimmune disease causes localized pain, they may suppress the immune system in the area just enough to stop the patient’s body from attacking the area and causing pain. Topical steroids can also do the following:

• narrow blood vessels
• reducing pain from varicose veins
• enlarged blood vessels
• and other venous or tissue damage

Because steroid topicals are the one class of topical pain reliever that can eventually reach the bloodstream with regular application, these drugs are usually only prescribed if other treatment methods have failed.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Only one main topical NSAID is approved for treating pain in the United States: diclofenac. The two most common formulas offer patients relief through a gel or cream. Diclofenac reduces pain by reducing localized inflammation and prostaglandins and may be especially useful for patients with osteoarthritis. Unlike oral NSAID drugs, the risk of adverse stomach and gastrointestinal side effects and/or heart complications is almost nil with topical NSAIDs, making their use much, much safer than oral medication alone.

Local Anaesthetics and Numbing Agents

Local anesthetics and numbing agents work by causing changes in how nerves perceive pain in the first place. If you’ve ever had stitches or had your mouth frozen at the dentist, you’ve experienced a local anesthetic first-hand; it makes the localized tissue feel virtually nothing but the sensation of pressure.

Numbing and anesthetic creams may contain a variety of substances, including:

• lidocaine
• tetracaine
• benzocaine
• prilocaine

The “caine” here is what matters; it refers to a particular class of drugs known to dull sensation.

The most common local anesthetics and numbing agents include over-the-counter formulas like Bacitracin, Neosporin, and Bactine — all commonly found in medicine cabinets across the country. These formulas are remarkably safe. Stronger prescription numbing creams can sometimes reach the bloodstream and may cause complications; thus, most physicians only prescribe them when necessary.

What Conditions Can Topical Pain Relievers Treat?

The list of conditions that may benefit from topical pain relievers is long — much too long to list in a single post. However, it is possible to “guesstimate” whether you may benefit from a topical based on your medical condition. Any time patients experience pain that’s either within the skin, soft tissue, or surface-level joints like the shoulder, the potential for benefit does exist. This includes:

• Fibromyalgia
• Soft tissue damage (e.g. bruising)
• Sprains, strains, and mild injuries
• Mild to moderate joint pain
• Osteoarthritis and/or psoriatic arthritis
• Certain painful skin conditions (like eczema or psoriasis)
• Certain cancerous melanomas and/or benign growths
• Everyday cuts, scrapes, and minor injuries
• Nerve pain that occurs within the first few dermal layers
• Other forms of arthritis-like pain (e.g. autoimmune, Rheumatoid Arthritis)
• Pinched or compressed nerve pain (e.g. sciatica, herniated discs in the spine)

What’s most important is that you recognize that topical pain relievers are still medications. Thus, you should never undertake treatment on your own. Your pharmacist is an excellent source of information; if you’re considering topical pain relievers to relieve your pain, ask for a consultation. He or she can help you to find the very best topical solution for your individual health profile.