Topical Painkillers
Creams, Patches, Injections and Other Pain Medications for Local Use
The main benefit of topical painkillers is that systemic absorption of the drug is negligible and thus there are rarely any side effects except for mild local reactions.
NSAIDs
Non-steroidal anti-inflammatory drugs include e.g. aspirin, ibuprofen and naproxen. Acetaminophen/paracetamol is sometimes counted in this group, but it is not a NSAID.
Topical NSAID preparations most often contain ketoprofen, diclofenac or piroxicam, formulated into a cream, gel, spray, mousse or even patches. There can be vast differences in absorption between the different products. In a French study ketoprofen was shown to have the best skin penetration with piroxicam doing worst. Gels are generally better absorbed than creams.
Most preparations are inexpensive and available without prescription. Unlike most topical painkillers, NSAIDs are well suited for acute use, though they may also relieve chronic pain.
Botulinum Toxin (Botox)
This powerful bacterial toxin is not just a cosmetological treatment; it is used for many painful conditions, such as muscle pain, temporomandibular pain and diabetic neuropathy. It may also work in fibromyalgia, myofascial pain and migraine/headache prevention. Botulinum toxin is given as an injection every 3-6 months.
Sarapin (Sarracenia Purpurea Distillate)
Sarapin is a preparation of the pitcher plant. It is used as local injections for myofascial and neuropathic pain and may also help in migraine and headache prevention. It has been available as a pharmaceutical pain therapy for decades, but there are very few studies of its use.
Sarapin is claimed to be free of side effects, but some people have described the injections as burning or otherwise painful. It is available in the United States, Canada and some countries in Europe and South America.
Topical Lidocaine
Lidocaine is a local anaesthetic used in minor operations and dental procedures. It can be used topically as a cream, gel, patch or spray. It is helpful for many different kinds of pain. In some countries small quantities are available without prescription.
Lidocaine Injections
Lidocaine can also be injected into a localized area of pain, such as myofascial trigger points. The pain relief can last for weeks or even months. There are usually no side effects besides local numbness.
Other Alternatives
Other possible alternatives include tricyclic antidepressants like doxepin (Sinequan) and amitriptyline (Elavil) and the muscle relaxant cyclobenzaprine (Flexeril) which is similar to amitriptyline. The anticonvulsants gabapentin (Neurontin) and phenytoin (Dilantin) are sometimes used topically for chronic pain. These drugs are not commercially available in topical forms and have to be prepared by a compounding pharmacy.
Thiocolchicoside is an analgesic drug which can be used both orally and topically. It has been used for back pain and temporomandibular pain and may be helpful in fibromyalgia. It is available in many parts of Europe, Asia and South America, but not in the United States or Canada.
Neomycin is an antibacterial drug mostly used in topical preparations. It has pain relieving properties separate of its antibiotic action. It is not commonly used as an analgesic, but could be tried for refractory pain.
Natural Options
For natural alternatives, see the article Natural Painkillers for Topical Use
References
Montastier P, Poiraud T, Poelman MC. Etude de la cinetique de diffusion in vitro de quatre AINS destins la voile percutane. Med du Sport. 1994;68:40-2.
