New Recommendation: Use Topical Pain Relievers First, When Treating Certain Injuries

Musculoskeletal injuries – like those that impact the ankle, neck, and knee – are common and lead to many visits to the emergency room (ER) or doctor’s office. In fact, 15% of all ER visits and three out of four injuries treated in doctors’ offices are musculoskeletal injuries. While these injuries rarely require hospitalization, doctors know they can seriously impact patients’ lives.

Recently, two of the largest doctors’ societies in the United States – the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) – released new guidance recommending the use of over-the-counter (OTC) topical nonsteroidal anti-inflammatory drugs (NSAIDS) pain relievers as a first-line therapy for treating acute, non-low back pain from musculoskeletal injuries in outpatient settings. These recommendations are on the heels of the Centers for Disease Control and Prevention (CDC)’s guidance to healthcare professionals to treat patients with topical pain relievers first.

In their guidance published in Annals of Internal Medicine, the ACP and AAFP recommend that physicians treat acute pain from non-low musculoskeletal injuries with topical NSAIDS, with or without menthol gel, as a first-line therapy. As a physician with over four decades of experience in medicine, I applaud ACP and AAFP’s new ‘topical first’ recommendation to provide people in pain with clinically proven OTC topical NSAID pain relievers.

In 2010 alone, musculoskeletal injuries accounted for more than 65 million healthcare visits. With rising costs of healthcare and the increasing awareness of the dangers of opioids, more doctors are turning to OTC topical NSAID pain relievers to treat pain resulting from such injuries. Topical NSAIDs are a safe and effective alternative to opioids and oral NSAID pain relievers.

Prescription opioid pain relievers are a leading cause of serious health complications. Additionally, taking too much of an oral OTC pain reliever that contains a NSAID can cause side effects, especially for people with heart disease and stomach trouble, that topical pain relievers do not.

What You Need to Know About OTC Topical Pain Relievers

What does it mean to be topical? Topical pain relievers, or topicals, are applied directly onto the skin over painful muscles or joints. Although they are all designed to relieve pain, different products use different ingredients. Common ingredients include menthol, lidocaine, camphor, capsaicin (found in chili peppers), methyl salicylate, and diclofenac sodium. Popular forms include patches, creams, gels, roll-ons, and sprays.

If using an OTC topical pain reliever, make sure to always read and follow the Drug Facts label. It will tell you everything you need to know about the medicine, including the ingredients, what you are supposed to use it for, how much you should take, and when you should not take the product.

Talk to your doctor or other healthcare professional if you have questions or concerns about which OTC pain reliever to take.

I am an active athlete who competes in paddleboard competitions. I’ve learned that as older athletes push to stay on top of their game, they run a greater risk of developing all kinds of aches and pains. During one competition several years ago, I took an oral OTC pain reliever and was nearly sidelined with acute gastritis Since then, I make sure I address pain with a topical patch first. It’s my recommendation people use a topical pain reliever first before moving onto oral medication.

Disclosure: Dr. Arnot is compensated by Hisamitsu to advise on pain management issues.

Dr. Bob Arnot

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Dr. Bob Arnot

Dr. Bob Arnot is an Emmy-award broadcast journalist and author with over 44 years of experience in medicine. He has run an emergency medicine service of nearly 100 hospitals, served as chief medical correspondent for NBC’s DatelineToday, and Nightly News shows, medical correspondent at CBS News, and continues today to cover the pandemic for a variety of national and international broadcasting platforms from Larry King and Fox to PBS and Al Jazeera. Dr. Arnot has also worked in many disease outbreaks as a medical doctor and a humanitarian board member for Save the Children and the UN High Commission for refugees including cholera during the Rwandan Genocide, Ebola in Uganda, Sleeping Sickness in South Sudan, malaria during the Mozambique foods, HIV/AIDS in Botswana, Zimbabwe and Haiti, and Dengue in Nicaragua. During COVID, he has been collaborating with one of the country’s leading medical centers to bring the latest advances to the medical community and general public.