Pain Specialists Awareness of Topical Analgesics and Their Use in Pain Control

Joseph V. Pergolizzi1,2*, Robert B. Raffa3, Robert Taylor4, Charles Fleischer4, Gianpietro Zampogna4, Lynn Nopper5, Frank DiLorenzo5, Clay M. Duval4, Alana N. Edun4, Jasmine Salamara5
1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
2Department of Pharmacology, Temple University School of Medicine, Philadelphia, PA, USA
3Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, PA, USA
4NEMA Research Inc., Bonita Springs, FL, USA
5Healthy Directions, Bethesda, MD, USA


Pain is inherently subjective and although it can be objectively measured using any number of validated tools, it often requires an individualized approach. According to the International Association for the Study of Pain (IASP), pain has been defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described by the patients in terms of such damage. Pain can be described in a number of ways: in terms of intensity (mild, moderate, severe, and very severe), duration (acute versus chronic), mechanism (neuropathic, visceral, nociceptive), and underlying disease (such as cancer pain). 

These factors may influence treatment choices, but analgesic products require prescribers to balance associated benefits against potential risks. Current approaches to pain control have not always offered satisfactory results. IASP states that some of the essential diagnostic criteria for acute musculoskeletal pain are pain and tenderness in a particular region in the absence of any serious pathology.

For acute pain, the goal is safe, effective, and rapid analgesia that allows mobilization and healing to take place. Both short- and long-term use of many pharmacotherapeutic regimens has been associated with safety issues, tolerability, and, in the case of opioids, tolerance, hyperalgesia, and misuse[6-8].

Toxicity issues have been raised with acetaminophen, tolerability with NSAIDs, and recent safety concerns with NSAIDs with respect to cardiovascular risks. This leaves many pain patients with limited therapeutic options and inadequate pain control. As international organizations declare that pain relief is a fundamental human right, physicians must balance concerns about unrelieved pain against safety issues.

Topical analgesic products offer a number of potential advantages for pain control in some patient populations. Unlike oral analgesics, topical products are designed not to be systematically absorbed and therefore may have less potential to produce adverse systemic effects. This can be of particular importance to athletes who may seek pain relief without concomitant systemic side effects such as drowsiness. Topical products can deliver medication directly to the site of pain with minimal adverse effects.

Topical products (applied to the skin surface at or around the painful area) differ from transdermal products (deliver the drug through the skin and result in systemic exposure to the drug) in that topical agents increase drug concentration at the application site with minimal systemic uptake and therefore low serum concentration.

Topical nonsteroidal anti-inflammatory drugs (NSAIDs), such as diclofenac and ibuprofen, require a prescription in the United States and include the same black-box warnings as all NSAIDs. Other topical products available over-the-counter (OTC) are more readily available to consumers, but there may be a lack of scientific evidence in support of their effectiveness and safety which makes it difficult for prescribers to recommend the right product for a particular patient. In fact, many healthcare professionals do not recommend or prescribe topical analgesics to their pain patients despite their potential advantages and utility.

The purpose of our survey was to determine if healthcare providers involved in the care of pain patients were aware of topical products, including OTC preparations, what they thought of them, and how they incorporated them into their practice. A better understanding of the knowledge, attitudes and perceptions of healthcare providers towards the use of OTC topical analgesics would provide clarity into their potential role as an option to manage acute and chronic pain.



Over-the-counter (OTC) topical analgesics are an important part of the armamentarium for pain management, but it was not clear if and to what extent prescribers discussed the option of topical analgesics with their patients.


The objective was to assess the extent to which pain specialists were aware of topical analgesics and how often and under what circumstances they recommended topical pain relievers to their patients to help control painful symptoms.


The authors conducted a convenience-sample survey at the PAINWeek® meeting in Las Vegas in September 2014. The survey was distributed during the conference and there were 81 respondents (healthcare providers).


Eight-five percent of all respondents (100% of pain physicians) indicated that they recommended OTC topical analgesics to patients and 81.5% said they had no concerns about the safety and tolerability of such products. When asked if topical analgesics could be a good first step in relieving muscle and joint pain, 98.8% of all respondents and 100% of pain specialist physicians expressed agreement.


OTC topical analgesics represent an important option for treating muscle and joint pain. They may offer specific advantages over other pain relievers in that they do not require high serum concentrations of the active agent and therefore may be associated with fewer side effects. OTC topical analgesic products can be easily obtained, self-administered, and allow for improved accessibility. Healthcare professionals specializing in pain are aware of topical analgesics and consider them safe, effective, and a good first-step product for treating musculoskeletal pain. Clinically tested OTC topical analgesics can be used with confidence as a first-line treatment for acute musculoskeletal pain.

For more info on the full survey, please click here.

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