FAQ Prescription Pain Cream
When is pain cream used?
Pain is one of the signs of injury, and can be bothersome for the patient. Chronic conditions such as arthritis can be bothersome, with its frequent attacks of pain and inflammation in the affected joint. Injuries and fatigue can cause soreness and tenderness of the muscles, ligaments, tendons, and other soft tissues of the joint. This may be common in athletes and the older segments of the population.
The most common route of administration for analgesic drugs is oral, i.e., swallowing pills containing medications such as non-steroidal anti-inflammatory drugs (NSAIDs). However, there is a limit to how much NSAIDs can be taken before damage to the stomach lining or kidneys occur.
Patients may also be unable to tolerate oral feeding, or may have reduced capacity for absorption along the gastrointestinal tract. The patient may also complain that pain is limited to a specific area only. In these cases, the use of a topical pain cream may be the most viable option to provide pain relief.
What are the types of pain cream?
There are three general classifications of the active ingredients used in pain creams, namely: local anesthetics, pain medications, and counter-irritants. Topical pain creams typically carry several active ingredients as a combination.
- Local Anesthetics – these include drugs such as lidocaine, which are used to relieve painful conditions such as sunburns. The effect of local anesthetics is to numb the nerve endings of the affected area, affording the patient relief of pain. The advantage of local anesthetics is that it affords quick relief once applied, although it usually only lasts for a short period of time before reapplication is needed.
- Analgesic medications – topical pain creams can contain drugs that actively inhibit the transmission of pain signals and directly reduce inflammation. NSAIDs such as diclofenac inhibit the inflammatory pathways and block the substances in the body that cause pain. Salicylates, which are the active ingredient in aspirin, can also be applied topically. Research has shown that salicylates can be as useful as NSAIDs in the treatment of chronic pain. Pain relief can also be afforded by narcotic pain relievers such as fentanyl.
- Counter-irritants – pain creams can afford relief from pain by “distracting” the brain. By providing another stimulus such as a warm or cool sensation, the mind is distracted from focusing on the pain. Pain creams can use counter-irritants, such as menthol, eucalyptus, camphor, or wintergreen oil that produce a cooling sensation on the skin. An example of this is Vicks VapoRub. Alternatively, pain creams can also use substances that cause a warming sensation to the skin, such as capsaicin, which is the main ingredient of hot chili peppers. Capzasin HP Arthritis is an example of a pain cream that uses capsaicin as an active ingredient. Research has shown that while capsaicin on its own is not as effective in the treatment of chronic musculoskeletal or neuropathic pain, it may be useful as an adjunct therapy or for cases that are unresponsive to other treatments.
What are the things to keep in mind when using pain cream?
- Never apply pain cream to dry or wounded skin – topical pain creams must never be applied to breaks in the skin or open wounds. There are substances in the cream, such as the counter-irritants, that can worsen the pain if applied to dry or wounded skin. Precautions should be taken to ensure that the pain cream is only applied to whole skin.
- Always read and follow the instructions in the product insert – each pain cream will have its own method of application and dosage frequency. The patient should be advised as to the correct regimen for maximum pain relief. As the medications are absorbed by the body through the skin, the possibility of overdose exists with topical medications.
Always wash hands after cream application.
- Make sure that there are no allergies to any of the ingredients in the pain cream – patients should be advised to avoid any pain cream that contains ingredients that they are allergic to. This could trigger an allergic reaction that could aggravate the condition. For example, patients with prior history of allergic reactions to aspirin should be advised against using pain creams with salicylates, such as BenGay.
- Wash hands after the application of the pain cream – patients should be advised to wash their hands after applying pain cream to get rid of any residual cream on their fingers. The residue can cause irritation if it gets into sensitive areas, such as the eyes or mouth.
- Avoid using pain creams together with heating pads or similar equipment – pain creams interfere with the body’s capacity to detect heat and pain. Using pain creams together with heating pads can cause burns, because the reduced sensitivity.
- Avoid using pain creams if there is an active infection of the skin – the presence of active infection causes changes in the local milieu, which can interfere in the absorption of the pain cream. This reduces the effectiveness of the pain cream, negating its benefits.
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 Mason L, Moore RA, Edwards JE, Derry S, McQuay HJ. “Topical NSAIDs for acute pain: a meta-analysis”. BMC Fam Pract. 2004 May 17;5:10.
 Matthews P, Derry S, Moore RA, McQuay HJ. “Topical rubefacients for acute and chronic pain in adults”. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD007403. doi: 10.1002/14651858.CD007403.pub2.
 Mason L1, Moore RA, Derry S, Edwards JE, McQuay HJ. “Systematic review of topical capsaicin for the treatment of chronic pain.” BMJ. 2004 Apr 24;328(7446):991. Epub 2004 Mar 19.