Topical analgesics are medicines that contain ingredients to reduce inflammation or pain.

• Topical = applied directly to the skin
• Analgesic = acting to relieve pain
• Anti-inflammatory = acting to reduce swelling and inflammation

These medicines usually come as gels or creams that are rubbed into the painful area. You can buy most topical analgesics from a pharmacy without prescription.

Topical analgesics are sometimes called ‘joint pain relief creams’, ‘muscle pain relief gels’, or similar.

There are many topical analgesic products, containing many different active ingredients, available for use as topical pain medicines.

Information in this article is mostly about products containing these active ingredients:

• ibuprofen
• diclofenac
• piroxicam.

In Australia, topical analgesics are used for temporary relief of pain and inflammation due to injury affecting muscles, bones or joints (the musculoskeletal system).

These medicines can be used for:

• osteoarthritis
• sprains and strains
• bursitis (inflamed areas between bone and tendons)
• tendonitis (irritated or inflamed tendons, such as tennis or golfer’s elbow).

There is still some uncertainty about which conditions topical analgesics work best for and which topical analgesics are most effective.

Different people will respond differently to different medicines – including topical analgesics.

What’s more, different forms of the same topical analgesic (gels versus creams, for example) can produce different levels of pain relief.

Consider trialling a topical analgesic first. Apply a small amount to a hidden area of skin overnight to find the medicine that works best for you, and check that you don’t have a bad reaction.

If you are unsure about what medicine to use or have other health conditions, ask your health professional.

The main topical analgesics recommended for musculoskeletal pain in Australia contain the active ingredients ibuprofen, diclofenac or piroxicam.

These active ingredients belong to a group of medicines known as non-steroidal anti-inflammatory drugs, or ‘NSAIDs’. You may also have seen some of these ingredients in over-the-counter medicines you swallow for pain relief.

Another active ingredient called capsaicin is also used for short-term relief of osteoarthritis pain. Capsaicin is an extract from chilli peppers, not an NSAID.

Different brands may be available in different chemists. You may come across the following:

• Apohealth, Chemist’s Own, Dencorub or Heron anti-inflammatory gels (diclofenac sodium 1%)
• Voltaren Emulgel or Osteo Gel (diclofenac sodium 1%)
• Voltaren Osteo Gel 12 Hourly (diclofenac sodium 2%)
• Nurofen Gel (ibuprofen 5%)
• Feldene Gel (piroxicam 0.5%)

If you are unsure about the best topical analgesic for you or how you should use it, ask your pharmacist.

The amount of topical analgesic you need depends on the medicine and size of the area that needs treating.

For example, ibuprofen 5% gel and diclofenac 1% gel can be applied three or four times daily, but diclofenac 2% gel should only be applied twice daily.

In general, for adults, a 1 cm to 4 cm piece of gel can be applied up to four times a day.

As a guide, this is half the size of an Australian 2-dollar coin (around 2 cm) to slightly larger than an Australian 50-cent piece (around 3 cm).

Remember these steps when planning to use a topical analgesic:

• always read the packaging and/or package leaflet before opening and using the medicine
• use the dose recommended on the packaging
• only use one topical analgesic medicine at a time
• only apply to healthy, unbroken skin
• rub gently into the affected area
• do not use a heat or ice pack on skin where you have recently applied a topical analgesic (unless your health professional has said it is OK).

Ask a health professional for help if you are unsure of which instructions to follow or if symptoms have not improved after 2 weeks.

All medicines, including those that are applied to the skin, have the potential to cause side effects.

After topical analgesics are applied, most of the medicine is found in the skin and tissues where it was rubbed in. This can lead to skin irritation or redness, itching or rash in between 1 in 100 and 1 in 1000 people who use a topical NSAID.

A very small amount of active ingredient is also absorbed into the blood stream, so very rarely people may experience any of the following:

• breathlessness
• nausea
• indigestion
• abdominal pain
• swelling
• gastritis (inflammation of the stomach)
• allergy
• contact dermatitis (inflammation of the skin following contact with the medicine).

NSAIDs can provoke asthma symptoms, although many people can take these medicines with very low risk of an asthma reaction.

If you experience a side effect that you think is due to a medicine you have taken, you can report it by calling the Adverse Medicine Events line on 1300 134 237.

Pain-relief active ingredients are often available in different forms.

For example, the active ingredient ibuprofen comes as a topical gel and an oral tablet (although they are different strengths and can have different uses).

Some people should not take oral NSAIDs because they can lead to side effects.

In some people, they could cause a heart attack, stroke, or bleeding of the throat, stomach and intestines (gastrointestinal system).

Do not take oral NSAIDs if you have ever had gastrointestinal bleeding, stomach ulcers, inflammatory bowel disease, a heart condition, if you have severe liver or kidney disease, or if you are pregnant.

For minor musculoskeletal pain, topical analgesics can be tried before oral NSAIDs.

For some types of pain, an oral analgesic may be more effective than a topical analgesic.

Always talk to your doctor or pharmacist before using topical analgesics if you have a heart or stomach condition, kidney or liver disease, if you are pregnant, or if you are also taking other pain-relieving tablets.

If you are unable to control pain with a single medicine, oral paracetamol and a topical NSAID such as ibuprofen, diclofenac or piroxicam may be used together.

However, if a topical anti-inflammatory (NSAID) is used at the same time as an oral anti-inflammatory medicine there may be a higher risk of side effects, including stomach irritation and bleeding.

Make sure you talk to your doctor or pharmacist before using any combination of medicines.

If you have questions about topical analgesics or other medicines, you can call the Medicines Line on 1300 633 424 (Monday–Friday, 9 am – 5 pm AEST).