Understanding Topical Analgesics

September 24, 2015

Dr. Sylvia Hesse touts ‘topical first’ when recommending pain medicine.

“When it comes to relieving the pain of achy joints, many people reach for a pain-relieving pill like aspirin or ibuprofen,” reports the Harvard Men’s Health Watch. “There may be a better way. When the source of pain is close to the surface, applying a cream, gel, patch, or spray that contains a pain reliever right where it hurts can ease pain and help avoid some of the body-wide side effects of oral pain relievers.”

The adult population seeks alternatives to systemic pain pills containing acetaminophen, naproxen and ibuprofen as the U. S. Food and Drug Administration (FDA) continues to flag new and very serious safety warnings on these pain pills that are both prescription and over-the-counter.  “Unfortunately, when people self-medicate with over-the- counter oral pain medications, they can ingest inappropriate doses and run the risk of potential drug interactions, which can lead to unintended or unsuspected dangerous side effects, some of which can be as serious as liver failure or heart damage,” says Dr. Sylvia Hesse, a NY-based non-surgical orthopedic specialist who believes in a holistic, multi-disciplinary approach to medical care.

“While taking an acetaminophen pill for pain is safe when following the package directions, problems can arise as the result of a single intentional or accidental overdose,” says Dr. Hesse. “Even frequently taking a dosage of acetaminophen that is too high can result in overdose. Acetaminophen is also a common ingredient in a wide variety of non-prescription and prescription products, and accidental overdose is often the result of taking multiple products that contain this ingredient.  Even though it is safe when taken appropriately, it can be very dangerous if you take too much, and overdoses can lead to death or liver damage.”

“Similarly, an overdose of ibuprofen can cause life-threatening heart or circulation problems, such as heart attack or stroke, especially if used long term,” adds Dr. Hesse. “Ibuprofen may also cause damage to the stomach or intestines, including bleeding or perforation.  These conditions can be fatal, and can occur without warning while a person is taking ibuprofen, especially in older adults. Consumers must remember that just because a product is available over the counter, doesn’t mean it’s not a potent medicine.  Any medication needs to be taken as directed.”

With these warnings, more and more people who experience muscle and joint pain are turning to topical analgesics to help provide relief for their symptoms.  Topical analgesic products are available in a variety of formulations, including gels, ointments, creams, lotions, and patches in single-entity or combination formulations.

As reported by the Mayo Clinic, the active ingredients in over-the-counter topical pain medications may include:

“The advantage of using a topical analgesic is that the medication works locally,” reports the Harvard’s Men’s Health Watch. “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 NSAIDs.”

“Topical analgesic medication, like a cream, gel, patch, or spray, provides a welcome alternative for pain sufferers, including those who prefer to avoid the use of oral OTC pain relief medication,” says Dr. Hesse. “Transdermal pain preparations penetrate directly to the site of the pain – providing a fast therapeutic benefit. Oral medications must travel through the digestive and circulatory system, and only a small proportion of the active drug is available before, ultimately, reaching their target tissue. Especially given all of the recalls that have happened lately with oral pain relievers, I find that my patients are looking for something that is safer and offers lower side effects.”

Other countries have demonstrated that topicals have an important role and should often be considered first line treatment for muscle or joint or back pain.  In Japan, for instance, 60% of OTC pain remedy treatment is in topical form and most of that is in patch versus 40% for systemic analgesics.  In China, Vietnam and much of Asia, it is common to see usage and consumption of topicals rivaling systemics.  In fact, the USA and Canada are among the two biggest pain pill popping nations in the world.

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