Topical Pain Relievers, Creams, and Gels

Helpful or Harmful?

Woman using topical pain reliever on leg
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Many athletes use over-the-counter topical pain relievers to treat muscle aches and pains. While these products offer temporary pain relief, athletes should be aware of some warnings and cautions before they reach for that tube of Bengay or Icy Hot.

Topical pain medications are applied directly to the skin and come in a variety of forms including creams, gels, lotions, and patches. There are three major categories of topical pain relievers from which you can choose.

Topical Analgesics Containing Salicylates

Salicylates (Methyl Salicylates), the same ingredients found in aspirin, are effective pain relievers that also reduce inflammation. The research, however, is inconclusive. A comprehensive 2009 review showed that salicylates may not effectively ease muscle pain when used as a topical cream applied to the skin, citing insufficient data. But despite the lack of evidence, many athletes continue to use these popular over the counter creams.

These creams are not recommended for use by those who are allergic to aspirin, due to an association between the development of Reye's Syndrome and the use of aspirin (a salicylate compound).

Brand name products include Bengay, Aspercreme, and Sportscreme.

Capsaicin Creams

Capsaicin is a compound found chili peppers that cause a hot, burning sensation. Capsaicin applied to the skin depletes a chemical (substance P) in nerve cells that help send pain signals to the brain.

Brand name products include Arthricare, Capzasin, and Zostrix.


These products contain ingredients such as menthol, wintergreen, peppermint or eucalyptus oil that makes the skin feel hot or cold. It’s thought that this distraction from the sensation of pain is what provides temporary pain relief.

Brand name products include Flexall 454, Icy Hot, and JointFlex.

Do They Work?

There is little evidence to conclusively show that these products successfully work, though the results are mixed.

While a 2004 review found limited evidence of the efficacy of sports creams, a 2010 study found that capsaicin cream provided relief for patients with chronic soft tissue pain as well as chronic back pain.

One comprehensive review of the literature, published in the Cochrane Database of Systematic Reviews in 2009, found little evidence that over the counter sports creams using salicylates have any effect at all on muscle aches and pain when compared with a placebo.

At the time of the study, lead researcher Andrew Moore of the Nuffield Department of Anaesthetics at the University of Oxford said in a statement that due to a lack of high-quality evidence, scientists were unable to ascertain whether sports creams and gels could be prescribed for chronic conditions like osteoarthritis. But Moore added there is some evidence to suggest that topical local anesthetics, topical capsaicin, and some topical NSAIDs may help reduce muscle pain from strains and sprains. "It is important to remember that not all analgesic gels or creams are the same, and for others there is very good evidence of effectiveness," Moore said.

Are They Safe?

When used moderately, and in accordance with the label directions, these topical medications are relatively safe. They should not be used long-term or in excessive quantities. It’s also important to realize that many of these medications often mask or suppress the natural pain signals of the body, and ignoring pain can increase your risk of further muscle or joint injury.

If you do use these medications for temporary pain relief, it’s important to rest your sore muscles, so try to avoid intense exercise until soreness subsides.


  • Side effects from these medications often include burning, stinging or irritated skin.
  • Never use these medications on broken or irritated skin.
  • Do not heat or ice your injury if you are using these topical medications and always wash your hands thoroughly after applying creams, lotions, or gels.
  • As stated above, creams containing salicylates should not be used by those who are allergic to aspirin.

Topical Pain Relievers and Overdoses

While extremely rare, it is possible to overdose on these topical pain relievers. An overdose occurs when someone accidentally or intentionally uses more than the normal or recommended amount of this product.

Overdoses can be serious, and sometimes life-threatening. Excessive absorption of the chemical methyl salicylate can lead to toxic levels in the blood and cause the same symptoms as an overdose of aspirin (nausea, vomiting, sweating, rapid breathing, and ringing in the ears) and possibly death. In fact, in 2007, a 17-year-old high school track athlete died after accidentally overdosing on methyl salicylate.

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Article Sources
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