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Topical pain medication creams - risks, benefits, and side effects

Updated on November 17, 2015

Topical creams

The advantages of topical medications

Before I tell you all of the risks associated with the use of topical medications, I think it's important to discuss how many benefits they have. Topical medications can be used to decrease the need for oral medications to treat pain, and, in some cases, completely replace oral medications. There are multiple benefits to the use of a topical pain cream, but they must also be used with caution.

Topical medications usually are not metabolized by the liver or kidneys, ultimately decreasing the risk of kidney and liver problems with long term use. There are benefits, sure, but this is the information that your doctor tells you, all the good stuff.

Did you know that there are also risks?

It is uncommon to find information about the risks of topical creams because most doctors focus on how it can benefit you so much by decreasing your need to take oral medications. When considered like this, yes, sure, a topical cream obviously will be less likely to cause long term problems when it is used for a chronic period of time to treat pain. But there is very little information available about what kind of risks are involved. The information that I have compiled is based on evidence based research, information from the FDA, and patient case studies, which I will discuss later in this article. First, let's talk about topical versus oral medications.

Risky business

The most dangerous of the topical medications that I mentioned is the topical lidocaine. It is sometimes given in a dermal patch formulation that is just applied to the painful area. The benefits of the patch are many: ease of use, no messy cream/gel, nice packaging, relatively inexpensive.

However, lidocaine is also available in a cream/gel. In 2007, the FDA issued a warning about the use of topical lidocaine. The FDA reported that patients who applied too much or who used it over large areas of their body or a lot of times per day can actually have some systemic accumulation. Lidocaine is a serious medication when used systemically, sometimes used for cardiac patients during life saving procedures. The FDA had not previously noted the possibility for systemic accumulation and, up until their advisory, the consensus was that it could be applied whenever, however, wherever, it didn't matter, it wouldn't end up in your blood stream. That is now proven to be wrong. Some patients had serious life threatening side effects and the FDA has now issued an update recommended the use of lidocaine as a patch only. Despite the advisory, it is all too common for pain management doctors to prescribe lidocaine as a cream and/or gel mixed with other agents. Often times, the doctor's that prescribe the lidocaine don't warn of the serious life threatening systemic effects. It is always important to ask your doctor to tell you the worst case scenario and get the full gamut of potential side effects with any medication, as has been shown in this example.

Some topical medications cause rash, dermatitis, discoloration of the skin, etc. Some topical creams can actually cause permanent discoloration of skin, so read the drug information carefully and/or ask your doctor.

Another serious concern is the risk of photocontact dermatitis with the use of topical Ketoprofen, which is a topical NSAID or anti-inflammatory medication. The FDA does not recommend topical use of Ketoprofen given the risk for photocontact dermatitis, which can cause scalding burns from sun exposure and a rash. However, as in the example with lidocaine, doctors continue to prescribe this topical medication for patients, often mixed with other medications. Always ask your doctor to tell you all the potential side effects before you use medications, and, as I have proven here, even topical medications.

Oral analgesics
Topical analgesics
Used in acute and chronic pain, effective for mild pain, used for multiple conditions, fairly inexpensive, non-prescription, generic, not expensive, taken every 4-6 hours
Used for acute pain, not proven effective for chronic pain, not indicated for pain that lasts greater than 2 weeks, applied locally to painful area 2-3 x/day, inexpensive, easy to apply
Muscle relaxants
Indicated for acute pain related to muscle spasm, short term use only, 2-3 weeks, prescription only, sedating, addictive with long term use, can interact with opioids and pain medications, controlled by FDA, doctors hesitant to prescribe
Topical formulation used locally for painful muscle spasm, prescription only
Anti-seizure medications
Indicated in the treatment of chronic pain related to neuropathy, first line for neuropathic pain, can be sedating, relatively well tolerated, not regulated by FDA, generic, prescription only
Applied locally for nerve pain, prescription only, expensive, usually combined with other agents
Glucoasamine is taken orally, for arthritis, mild pain, effects work over a period of weeks, safe to use long term, minimal side effects, no interactions with other drugs, over the counter
Capsaicin and Glucosamine are available topically, only recommended when oral medications don't work or aren't tolerated, moderately priced, applied locally for arthritis and nerve pain
When used orally, it is only used in limited settings, not used for pain relief
Used topically for nerve pain, available as patch, cream, gel, applied locally to area, not really helpful for the spine or shoulder, relatively non-expensive


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