Topical painkillers are available as creams, salves, gels, and patches. They work to reduce pain in several ways.
Some commonly used counterirritants contain menthol, eucalyptus oil, oil of wintergreen, camphor, eugenol from cloves, and/or turpentine oil. When rubbed on the skin, these arthritis creams or ointments create a feeling of cold or heat over the painful joint or muscle, which may help soothe painful arthritis joints. Popular brands include Therapeutic Mineral Ice, Icy Hot, and Tiger Balm.
Of topical pain medications, capsaicin, an ingredient found in cayenne peppers and available in over-the-counter creams and ointments (Capzasin-P, Dolorac, Zostrix), probably has been studied the most.
Capsaicin cream warms the skin when applied over the joint and temporarily blocks a chemical called substance P, which delivers pain messages to the brain. It has shown some effectiveness in trials for osteoarthritis and rheumatoid arthritis and is a useful adjunctive therapy for some people. Remember to use disposable gloves when applying capsaicin cream, and avoid getting it in your eyes, nose, and mouth.
Other arthritis creams are available that contain salicylates, compounds related to aspirin. These compounds work by decreasing pain and inflammation. Using topical salicylates may help you avoid most of the side effects of taking aspirin by mouth, but how well it works to relieve pain is unclear. Some brand names include Aspercreme, Bengay, Flexall, and Sportscreme.
NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen and naproxen, are commonly taken by mouth to relieve arthritis pain. Arthritis creams consisting of NSAIDs, commonly used in other countries, are starting to become available in the U.S.
Topical NSAIDs penetrate the skin barrier and deliver the medication to the site of pain. Although studies show that they give short-term relief only, it is likely that the topical route is safer than taking NSAIDs by mouth. There are several available products by prescription. Pennsaid and Voltaren gel are examples.
Lidocaine patches are another alternative pain remedy for arthritis joint pain. Lidocaine is a drug that blocks transmission of nerve messages. It acts as an anesthetic, an agent that reduces sensation or numbs pain. In findings presented at the American Pain Society's annual meeting in 2005, researchers reported that 143 patients with knee osteoarthritis pain either used the Lidoderm patch, which contains lidocaine, once daily for 12 weeks, or took Celebrex, an NSAID, by mouth. At 12 weeks, 71% of both groups reported at least a 30% improvement in their knee pain, which is considered significant pain relief.
Arthritis creams, salves, gels, and patches are usually well tolerated. However, skin irritation is possible. Symptoms of skin irritation include redness or burning where you applied the cream or patch. If you notice any of these symptoms, talk to your doctor to see if you should stop using the product. Allergic reactions can also occur. If you have signs of a severe allergic reaction -- hives, difficulty breathing, closing of the throat, swelling of the lips, tongue, or face -- you should stop using the product and seek emergency care or call your doctor immediately.