Sep 08, 2022
2 minutes reading
Garofoli MP. Scratching the surface: a review of topical pain relievers from Rx and OTC. Presented at: PAINWeek; Las Vegas; Sept 6-9, 2022.
Garofoli reports that he serves on an advisory board for Hisamitsu.
LAS VEGAS — Physicians should make specific product recommendations to patients for over-the-counter pain relievers to avoid confusion among hundreds of pain-relieving choices at the pharmacy.
During his presentation at PAINWeek 2022, MarkP. GarofoliPharmD, MBA, BCGP, CPE, CTTS, clinical assistant professor and pharmacist for clinical pain management at West Virginia University Schools of Pharmacy and Medicine, reviewed the ingredients and uses of many of the currently available topical analgesics.
“There’s a lot of confusion and concern about things that aren’t opioids,” he said. “The OTC path is overwhelming for people.”
His advice: remember the basics. “Topically means ‘apply here, work here,'” he said. “Transdermal means ‘apply here, works everywhere’.”
Garofoli presented a chart that divided topical ingredients into four categories: anti-irritants, narcotics, anti-inflammatories and others.
Counter-irritants can be divided into hot and cold treatments, he said. Heat causes vasodilation and should be used for muscle tension or knots. Cold causes vasoconstriction and should be used for muscle spasms.
Methyl salicylates, hot counter-irritants, are available in OTC combination form in products from Salonpas (Hisamitsu), Tiger Balm (Haw Par Corp.), Bengay (Johnson & Johnson), and Icy Hot (Sanofi). Products that also contain trolamine salicylates include Aspercreme (Sanofi) and Sportscreme (Chattem).
Capsaicin, another warm anti-irritant, can be found in Capzasin (Chattem) and Zostrix (Prestige). Some Salonpas and Tiger Balm products contain capsaicin along with camphor, menthol and essential oils.
A prescription capsaicin product, the Qutenza 8% Patch (Averitas Pharma), is FDA-approved for use in patients with diabetic peripheral neuropathy of the foot and post-herpetic neuralgia.
Cool counter-irritants are products that contain camphor, menthol and essential oils, Garofoli said. Some combination products from Salonpas, Bengay and Tiger Balm contain these ingredients, and some combination products from Tiger Balm and Aspercreme also contain essential oils, he said.
Topical narcotics contain lidocaine and include products from Salonpas, Bengay, Icy Hot, Aspercreme, and a number of other brands.
Topical anti-inflammatories may contain CBD or diclofenac, Garofoli said. Flector (diclofenac 1.3% patch, IBSA) is FDA-approved for acute pain due to minor strains, sprains, and bruises, while Licart (diclofenac 1.3% patch, IBSA) is FDA-approved for topical treatment of acute pain due to minor strains, sprains and bruises. Pennsaid (diclofenac sodium 1.5% solution, Horizon) is FDA-approved for osteoarthritis of the knee.
Voltaren gel (diclofenac sodium 1% topical gel, GlaxoSmithKline), intended for joint pain in osteoarthritis, was approved by the FDA in 2020 for non-prescription status.
Garofoli’s “other” topical pain reliever is the antidepressant Zonalon (doxepin 5% cream, Doak Dermatologics), which can be used for itching or neuropathic pain.
Garofoli said emu products, which contain omega-3, omega-6 and omega-9, are becoming popular for use in arthritis, hypocholesterolemic effect, mucositis, irritable bowel disease, bone loss from cancer chemotherapy, hair loss and short-term mosquito repellent.
Additional topical pain relievers include Bio Freeze (menthol, Reckitt), Deep Heat (methyl salicylate, Mentholatum Australasia), Vicks VapoRub (menthol, camphor, eucalyptus oil), and Mineral Ice (menthol, Crown Therapeutics).