Pain relievers come in all forms, including medication applied to the skin. Get on-the-spot topical therapy for pain relief from creams, patches, and sprays. There are many topical pain relievers; pain-relieving medications applied to the skin, including creams and patches. Topical pain relievers are often used by patients who cannot take oral medications.
Consider these three main types of pain medication applied to the skin:
Local anesthetics: These are medications that numb painful areas for short periods of time. They have a variety of uses. Lidocaine patches, for example, can help to relieve the burning, stabbing, chronic ache that may occur after a shingles infection: a condition called post-herpetic neuralgia. Dentists may also use a topical anesthetic on the gums to help ease the pain of an injection. Some topical local anesthetics are available over the counter in spray and gel form to treat the sting of a sunburn.
Pain medications: Medications applied to the skin include drugs such as the non-steroidal anti-inflammatory drug diclofenac (Solaraze, Pennsaid), which works by reducing inflammation in a localized area of the body, or aspirin creams, which work by blocking substances in the body that cause pain. Alternatively, these topical medications may contain narcotic pain relievers, such as fentanyl. Though some of these topical pain relievers (Aspercreme, BenGay) are available over the counter, some are dispensed by prescription only.
Counter-irritants: These are products that contain substances such as menthol, eucalyptus, or oil of wintergreen that irritate nerve endings, producing a “cool” feeling on the skin and distracting the brain from deeper sources of pain. Vicks VaporRub is an example of a counter-irritant.
Muscle pain is generally a secondary pain originating due to guarding, shielding, and posturing due to original pain sourcing. Most patients are aware when their muscles start to “tighten”, they become uncomfortable and are warning of impending pain. The precursors are:
- Loss of motion
- Extreme tightness -not unusual to palpate and the muscles hard as rock
- Posture shifting to avoid additional stress to the muscle group
- Potential headaches – especially for upper shoulder, neck areas
It is when the precursors are noticed that defensive intervention is needed. The process can be halted and reversed with proper treatment. By using electrodes that cover much of the neural origins of the muscle group a pleasant sensation is introduced using the tens or interferential unit on a “high” setting (equal to or greater than 70 pps – pulses per second for tens, 4,070 pps for interferential). The pleasant sensory sensation actually reduces the tension and prevents further guarding/shielding before the muscle pain starts. Using interferential for short 20 – 30 minute treatment time periods can stop the muscle pain completely when used as a preventive for several weeks. If a patient experiences tightness then a proper treatment would be to treat the muscles early in morning prior to starting the day or late at night prior to sleeping’ The relaxing treatments may help the patient actually sleep, or prevent muscle tightness as the person begins activities which normally result in muscle pain.
For many chronic pain patients, there is a continuing problem associated with muscle pain. The patient may experience tightness, tension in an area, and in the worst of situations, actual spasms causing excruciating pain. Spasticity often is present following surgical procedures such as total knee replacement of other invasive surgical procedures where the muscle tissue is literally cut. To go into spasm, following cutting, is extremely agonizing. As a general rule, pain in muscles is one of the simpler pain syndromes that can be totally eliminated using electrotherapy such as tens or interferential therapy. The biggest issue is not to treat muscle pain, but to prevent it from ever occurring in the first place. One of the warnings for anyone using a tens unit, transcutaneous electronic neural stimulator, or an interferential unit is this:
“This device should not be worn while driving or operating machinery….”
The purpose of the statement is that during stimulation, it is not uncommon for a patient’s muscles to actually relax and the patient is able to lose the tenseness, the pain, and becomes drowsy because the muscle pain and tightness evaporates. It is more common for any chronic pain patient that has been experiencing muscle pain continuously for long periods of time. The change is welcome relief. The best treatment protocol is to never allow the muscle pain to start but with chronic pain patients it’s rare for any patient to have effective intervention prior to the muscle pain starting.
Also if the patient engages in activities during the day that normally results in muscle pain then by using a portable tens or portable combination Interferential & Tens device the unit can be worn and actually on for treatment while the activity is being performed. Over time the use of interferential to prevent muscle pain and tightness seems to be a form of biofeedback for the patient who learns to “slow down and relax” once the precursor symptoms start. There is knowledge there is a physical modality to use if needed and eventually the modality is used less frequently since the pain patient now has control. With interferential due to the much longer carryover pain relief, which tens does not have, a simple arnica pain patch worn around the muscle may be sufficient for effective prevention and the pain totally eliminated.
Side effects from topical medications include redness, itching, and other skin irritation. They are generally mild-and uncommon. The cause of skin irritation is often the material used to make the cream or gel, not the NSAID. A topical analgesic may not be the best choice when pain affects an extended area, like the lower back, or affects more than one part of the body. Do not use topical analgesic if one is also taking an oral NSAID; either prescription or over-the-counter- without informing the doctor. Taking too much of an NSAID can land one in the hospital with stomach bleeding or an ulcer flare-up.
USES OF TOPICAL ANALGESICS
The advantage of using a topical analgesic is that the medication works locally. Targeting pain more precisely using a medication applied to the skin can help skirt the side effects of oral drugs. This can be a boon for people whose stomachs are sensitive to NSA|Ds. Note that a small amount of the medicine still enters the bloodstream and ends up in the stomach and elsewhere, so a topical analgesic is not a guarantee against NSATD-related stomach irritation. Other people seek topical NSAIDs because they want to avoid adding another pill to their daily regimen, or have trouble taking pills.
Topical analgesics can be applied two to four times a day to control mild to moderate pain. Make sure to wash your hands thoroughly after use so one does not smear the drug into the eyes, nose, mouth, or other mucous membranes.
There is another topical agent available which is over-the-counter named capsaicin. This medication works on a receptor in the skin which is a sensory receptor and can help turn it off and decrease pain. Capsaicin is made as an extract from chilli peppers so a lot of people call it pepper cream. Capsaicin is available as a cream, it is also available in a patch format which unfortunately is fairly onerous to apply because of the potential for aerosolized the medication which can be caustic. More and more, the potential exists for topical medications to help minimize the amount of oral medications needed for pain relief which can hopefully decrease potential side effects. More research continues to come out showing that the skin is extremely important in pain generation and a lot of patients so the potential for these topical medications is tremendous.
Menthol is derived from peppermint oil or other varieties of the mint family. There exist more than 550 species of the mint plant, which grows almost exclusively in the temperate zones. Menthol has been applied as a medicinal remedy for more than 3 millennia, starting with the ancient Greeks and Egyptians. Then, it was thought that mint could provide clarity of thought and rouse the passions.
Today, in addition to its medicinal qualities, the mint plant offers its menthol properties to many sweets, and even to mouthwash, cigarettes and culinary creations. But it is menthol’s medicinal qualities that we are most interested in here.
Menthol is a minty product, which is available in white crystals form that’s extracted synthetically from peppermint essential oil. It contains 70% of menthol, which make it so, beneficial for health. It has antibacterial and anti-fungal properties, which make it highly demanded in various pharmaceuticals and cosmetic industries. It is also known for its sweet aroma, minty flavor, and cooling effects. It is originally known as Japanese mint.
It’s most common and purportedly useful applications include:
- In tea, to help cleanse the liver and reduce the occurrence of kidney stones
- Cleansing skin blemishes such as acne
- For the elimination of facial tics and spasms
- To suppress nervousness, and reduce stress and depressions
- In cough medicines and lip balms, to relieve sore throats
- As a common addition to chloroform sprays, for the relief of localized pain
- For its anti-viral properties, to combat herpes and other viruses
- As a way of providing instant relief from the torment of toothaches
- In topical analgesics to relieve headaches, migraines, muscle cramps and minor sprains
- To reduce muscle and joint inflammations
- Decongestants for nasal and chest congestion
- For the treatment of sunburns and other burns to the skin
- As a remedy for skin rashes, poison ivy, itching, athlete’s foot and the like
- To be applied on poison ivy rash, diaper rash and athlete’s foot
- To relieve bad breath
- By air travellers, to help with the symptoms of motion sickness and with jetlag
- In first aid products to produce a cooling effect for serious burns
- In patches applied to children’s foreheads, to reduce fevers
- As a tea, to ease the discomfort of bronchitis and to aid those suffering from digestive disorders, flatulence and to counteract vomiting
- To massage on the scalp, to reduce dandruff
- In female sexual dysfunction cremes and gels, where it acts as a vasodilator and neuro-stimulant
- To relieve menstrual cramps
- As a libido enhancer for male sexual dysfunction
- To strengthen the muscles of the heart
It has so many health benefits and uses in various applications such as:
- Food Production
- Oral hygiene
As can be seen, many of the applications of menthol relate to the skin, because of its ability to provide instant cooling, as well as its antibacterial properties in dealing with localized traumas. It is thought that the cool feeling experienced when menthol is applied to a specific area is due to its reaction with the skin’s thermoreceptors. There are more thermoreceptors in the body that are designed to feel cold than those that are heat sensitive. The chemicals in menthol trigger the nerve cells in the area to which the menthol is applied, and since there are more cold-sensitive thermoreceptors, cool sensation is felt.
It is sometimes known as Lignocaine, Lidocaine is a compound that is widely known as a good treatment for back pain relief. This is a local anesthetic and is also used as an anesthetic for insignificant surgeries and likewise for dental surgeries. This application for lower back pain is available in patches that can be applied on the skin. This patch contains only 5% Lidocaine and is known to always show positive results though the duration of the relief varied greatly and depends from patient to patient. Patients of arthritis have been extensively treated with Lidocaine and have shown positive results with little or no side effects. Lidocaine works by blocking the pain signals at the nerve endings and numb the nerves blocking all pain signals to the brain. This is very effective treatment especially for patients suffering from arthritis.
One of the methods of administration of Lidocaine is through injections directly into the back. This treatment lasts for just a couple of hours and so is rarely used except in dire emergencies. This treatment is mostly used to confirm a diagnosis and for locating the exact muscle that is causing the problem.