Topical pain-relieving drugs are preparations applied to the skin as a cream, ointment, gel, or spray. Topical "drug" applications are used to help reduce inflammation below the skin surface and alleviate nerve pain. Some of these drugs are available only with a doctor's prescription and others can be purchased over-the-counter (OTC).

Spine specialists may recommend the use of a topical pain-reliever to help relieve the symptoms of osteoarthritis, rheumatoid arthritis, neck or low back sprain/strain, whiplash, muscular and joint pain, and some types of nerve pain. Two common types of topical pain relievers are local anesthetics and analgesics.

• Local anesthetics are substances used to reduce or eliminate pain in a limited area of the body. These work by blocking the transmission of nerve impulses. One type of local anesthetic combines lidocaine and prilocaine (EMLA®). It numbs the skin for a period of two to three hours and is helpful to reduce pain prior to injection or insertion of an intravenous line (IV).

• Analgesics are non-steroidal anti-inflammatory drug (NSAIDs) preparations in cream, ointment, or gel form. Topical analgesics are used to reduce swelling and ease inflammation that can cause pain.

Over-the-Counter Products
The use of topical pain-relieving agents is not a new concept. Products such as Lanacane® or Solarcaine® , both available OTC, have been used for years to treat minor sunburn, abrasions, and cuts.

Corprofen™ pain relief cream, BenGay® and IcyHot® are examples of OTC drugs used to help relieve joint pain commonly associated with arthritis. These preparations work primarily as local anesthetics without analgesic compounds added. Aspercreme®, Sportscreme®, and Myoflex® - available OTC, contain a type of salicylate; a chemical substance similar to, but not aspirin.

Topical Analgesics
Newer types of topical pain-relieving creams, ointments, and gels have become available and contain NSAIDs such as ibuprofen and dilofenac (Voltaren® Emugel). These topical preparations work to reduce swelling and inflammation of soft tissues (tendons, ligaments, muscles) caused by trauma or disorders such as osteoarthritis and rheumatoid arthritis.

Capsaicin
Another type of topical preparation contains Capsaicin (Zostrix®, Dolorac®). These prescription preparations work by reducing the levels of the chemical substance P, which is involved in transmitting pain impulses to the brain.

Important Considerations
Whether the topical preparation to be used is purchased OTC or prescribed, keep in mind the substance is a drug. That is why it is important that the patient discloses their medical history, including prescription, OTC, supplements (e.g. vitamins, herbs), and allergies to their treating medical professional.

Other medical conditions may affect the use of a topical pain-relieving medication. These conditions include:

• Broken or inflamed skin, burns, open wounds.

• Atopic dermatitis or eczema (skin disorders).

• Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency (a type of anemia).

• Severe liver or kidney disease.

• Methemoglobinemia (defective iron in the red blood cells; inhibits oxygen delivery to tissues).

• Intolerance to certain oral medications.

• Asthma.

Safe and effective use of a topical pain-relieving agent involves many of the same considerations as if taking an oral medication.

(1) Take the time necessary to review the package insert.

(2) Use as directed or prescribed.

(3) Do not apply topical pain-relieving preparations to open wounds, burns, broken or inflamed skin.

(4) Avoid applying near the eyes, lips, mouth, and ears.

(5) If accidentally swallowed, contact a poison control center, doctor or hospital immediately.

(6) If a rash, side effects, or allergic reaction develops, contact the treating physician at once.

Conclusion
When used appropriately, topical preparations can help reduce or alleviate pain caused by osteoarthritis, rheumatoid arthritis, and soft tissue trauma. Patients whose pain is relieved using topical agents require lower doses of oral medications. This means they can avoid many of the harmful side effects associated with oral drugs.