Do topical pain creams and patches work? What the evidence says

Some topical pain ingredients have real, if modest, support behind them, and some pain creams sold online lean on ingredients with much less. In the public sources we could open, capsaicin, lidocaine and diclofenac appear as over-the-counter or prescription topical options with specific directions, while menthol works mainly as a warming or cooling sensation and has a documented burn risk at higher strengths. What matters most is the printed concentration, the directions and your own health situation.

This guide covers what federal health sources say about common ingredients in pain creams, gels and patches, what the FDA has warned about, and how to read the sales pages of online products in this category. It is general information, not medical advice. Pain that is severe, new, or lasting more than a week deserves a conversation with a doctor or pharmacist, and the labels below say the same.

Is a pain cream a supplement or a medicine?

It depends on what the product is and what it claims, and the difference matters. The National Center for Complementary and Integrative Health (NCCIH) explains that federal law defines dietary supplements as products you take by mouth, such as a tablet, capsule, powder or liquid. A cream, gel, patch or roll-on is applied to the skin, so it falls outside that definition, and different rules apply to it than the supplement rules we describe elsewhere on this site.

The FDA describes over-the-counter medicine as safe and effective when you follow the directions on the label and as directed by your health care professional. That sentence is worth reading closely: the safety statement is tied to following the label. A product that shows no concentrations, or that tells you to use it differently from its own label, is asking you to trust it without the information that safety statement depends on.

What does the evidence say about capsaicin?

Capsaicin is the substance in chili peppers. MedlinePlus lists topical capsaicin as an over-the-counter product used to relieve minor pain in muscles and joints caused by arthritis, backaches, muscle strains, bruises, cramps and sprains. The National Center for Complementary and Integrative Health, in its chronic pain overview, says there is evidence that topical products containing cayenne, such as creams and plasters, can reduce low-back pain.

The picture is not one-sided. In a separate NCCIH page on osteoarthritis, a 2013 evaluation of topical herbal products concluded that arnica gel and comfrey extract gel might be helpful, and that capsicum extract gel probably is not. The evidence on other products was insufficient to reach conclusions. NCCIH also notes that some products, such as capsicum extract gel, can cause skin irritation or other side effects.

The directions are stricter than most people expect. MedlinePlus says topical capsaicin may cause burning at the application site that generally disappears after several days, and to stop using it and call a doctor right away if severe burning occurs. It says not to apply it to broken, damaged, infected or rash-covered skin, not to wrap or bandage the area, to protect the area from heat such as heating pads, hair dryers and heat lamps, and to avoid applying it right before or after a shower or vigorous exercise. You should also wash your hands afterwards and keep it away from your eyes, nose and mouth.

What about lidocaine?

Lidocaine is a local anesthetic, which works by stopping nerves from sending pain signals. MedlinePlus lists nonprescription lidocaine patches, a 4% strength, for minor pain in the shoulders, arms, back, neck and legs in adults and children 12 and older. They are applied 3 to 4 times daily and for no more than 8 hours per application. A prescription 5% patch exists for a different problem, the burning pain that can follow shingles.

MedlinePlus also says to stop using the nonprescription patch and call a doctor if pain lasts longer than 7 days or if pain improves and then worsens. That is a useful rule of thumb for the whole category: an over-the-counter topical is for minor, short-term pain, not for a problem that keeps coming back.

Do OTC diclofenac gels count as a topical pain reliever?

Yes, though it belongs to a different family. MedlinePlus describes nonprescription diclofenac 1% gel (sold under the name Voltaren Arthritis Pain) as used to relieve arthritis pain in joints such as the knees, ankles, feet, elbows, wrists and hands. It is a nonsteroidal anti-inflammatory drug, applied up to 4 times daily to up to two body areas for up to 21 days, or as a doctor recommends.

The page also carries a warning that people who use NSAIDs may have a higher risk of heart attack or stroke, and that it may take up to 7 days to feel the full benefit, with instructions to stop and contact a doctor if there is no relief after 7 days. Diclofenac matters for this article for another reason: some online pain drops borrow the reputation of drug-delivery research. Our Arctic Blast review notes that the best-documented use of DMSO is as a penetration enhancer for a real drug, topical diclofenac, and that the page implies DMSO alone relieves pain. It also notes that the six active ingredients list no concentration.

What did the FDA warn about menthol and similar rubs?

The FDA warned that some consumers reported serious skin injuries with certain over-the-counter muscle and joint pain relievers containing menthol, methyl salicylate or capsaicin. It described 43 reported cases of burns. In many cases the burn occurred after just one application, with severe burning or blistering within 24 hours, and some cases needed hospitalization. A majority of the more severe burns involved menthol or menthol and methyl salicylate combination products, most of them with higher concentrations (more than 3% menthol or more than 10% methyl salicylate). Few of the cases involved capsaicin.

The FDA also said there is no way to predict who will have this kind of reaction, and noted that the number of cases is very small compared with the number of people who buy these products. Its advice was specific: do not apply to damaged or irritated skin, do not bandage the area, do not apply heat with pads, hot water bottles or lamps, and keep the products away from eyes and mucous membranes. If you feel actual pain or see blistering, stop using the product and seek medical attention.

That advice is why a missing concentration is a real problem. The Insta Soothe review covers a menthol, arnica and aloe cream that gives no percentage for menthol or arnica. The Balmorex Pro review notes that the sales page says the cream is safe to use with other pain relievers while the label warns not to use it with other ointments, creams or liniments. When the page and the label disagree, follow the label and ask a pharmacist.

How do you read an online pain cream page?

Use the same questions you would ask about any product, plus a few specific to topicals.

• Is each active ingredient listed with an amount? The Roll On Relief review credits the label for printing exact milligram amounts of camphor, menthol and peppermint oil, which is uncommon in this category. It also notes several other ingredients at fractions of a milligram per serving.
• Does the cited research match the product? A study on an ingredient by itself, at a different strength, is not a study of the cream.
• Do the directions match the safety advice above? Look for a warning about broken skin, bandaging and heat.
• What is the refund condition? Some require you to mail back all the bottles, even empty ones, as noted in the Roll On Relief review.
• Is a story doing the work of evidence? Coined terms and long origin stories are not clinical data.

You can compare more formulas in our joints and mobility category.

FAQ

Which topical pain ingredient has the most evidence?

The sources we opened give the strongest wording to cayenne (capsaicin) creams for low-back pain, and list arnica and comfrey gels as possibly helpful for osteoarthritis. Evidence for most other ingredients is limited. A pharmacist can tell you which option fits your situation.

Is it safe to use a heating pad with a pain cream?

No. The FDA advises against applying heat with a heating pad, hot water bottle or lamp to skin where a menthol, methyl salicylate or capsaicin product was applied, because doing so increases the risk of serious burns. MedlinePlus gives similar advice for capsaicin and lidocaine.

How long should I use a topical pain product?

Follow the label. MedlinePlus advises stopping nonprescription capsaicin or lidocaine products and calling a doctor if pain lasts longer than 7 days, gets worse, or improves and then worsens. Diclofenac gel has a 21-day limit unless a doctor advises otherwise.

Can a pain cream replace seeing a doctor?

No. A cream may reduce a minor ache, but it does not tell you what is causing the pain. Talk to a doctor if the pain is severe, follows an injury, or keeps returning.