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Topical Analgesics

Introduction

Topical analgesics are medications that are applied on or gently massaged into the skin to temporarily relieve pain of muscles or joints in several forms such as creams, gels, ointments, transdermal patches and sprays.


Common topical analgesic products

Commonly used topical analgesic products can be generally classified into three categories including counterirritants, non-steroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics:

  1. Counterirritants: They work by producing less severe pain to counter a more intense one. Common examples include methyl salicylate, menthol, camphor and capsicum extract.
  2. NSAIDs: They provide analgesic effects by interfering with cyclo-oxygenase 2 (an enzyme regulating the release of prostaglandins, which are responsible for pain and inflammation). Common examples include diclofenac, piroxicam, ibuprofen, indomethacin and ketoprofen.
  3. Opioid analgesic: They are absorbed through skin to inhibit the central nervous system from receiving pain sensation. Common examples include fentanyl and buprenorphine.

All topical analgesic products provide temporary pain relief only, please use as directed by your doctor or pharmacist; or use exactly as directed on the label/package inserts to prevent adverse effects from overdosing or poisoning (e.g. salicylate poisoning). If you suffer from chronic or severe and unbearable pain, please consult or seek advice from a doctor.


Common side effects*

  1. Topical counterirritants: skin redness, burning sensation, itching, rash, etc.
  2. Topical NSAIDs: skin rash, itching, reddening, skin irritation, photosensitivity, etc.
  3. Topical opioid analgesics: constipation, sleepiness, nausea and vomiting, tiredness, dizziness, headache, abdominal pain, etc.

If you experience any signs of allergy including skin rash with blisters, hives, wheezing or swelling of the face, lips, tongue or throat, stop using the product and consult a doctor immediately.


General precautions*

  • Do not exceed the recommended length of treatment/stated dose.
  • Do not cover treated skin with a bandage or heating pad.
  • Avoid contact with the face, scalp, eyes or mucous membranes when in use.
  • Avoid applying over large areas of skin.
  • Avoid applying the product on broken skin
  • Avoid using topical products containing methyl salicylate in children who have flu, chickenpox or fever
  • Do not use topical NSAIDs if you have a history of hypersensitivity to salicylates (e.g. aspirin) or any other NSAIDs, which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAIDs.
  • Consult your doctor before using any topical products that contain salicylates (e.g. methyl salicylate) if you are taking blood thinners.
  • Consult your doctor before using any topical products that contain methyl salicylate if you are allergic to salicylic acid.
  • Avoid excessive exposure to sunlight of area treated with topical NSAIDs in order to avoid possibility of photosensitivity.
  • Consult or seek advice from a doctor before the use of topical analgesics by children.
  • Consult your doctor before using any topical analgesics if you are pregnant or breastfeeding.

Additional precautions when using opioid transdermal patches (i.e. fentanyl or buprenorphine)*:

  • Avoid using consecutively on the same site.
  • Do not cut the patch without medical advice.
  • Do not drink alcohol, drive or operate heavy machinery.
  • Use the opioid transdermal patch as directed by your doctor. Do not stop using it without consulting your doctor.

General advice on using topical analgesics*

  • Always follow instructions from your doctor or pharmacist; or use exactly as directed on the label/package inserts.
  • Stop using the product and consult your doctor immediately if allergic reaction occurs.
  • Wash hands after using the products. If using the medicine to treat an area of your hands or fingers, wait at least 30 minutes before washing your hands.
  • Consult your doctor if the condition worsens, or if symptoms persist for more than 7 days or clear up and occur again within a few days.


Storage

Topical analgesics should be stored in a cool dry place. Unless specified on the label, medicines should not be stored in refrigerators. Furthermore, medicines should be kept properly in places unreachable by children to prevent accidental ingestion.

* Information contained herein may not cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects.


Drug Office
Department of Health
Dec 2022
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