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How to decide on whether a topical treatment Is right for your

New products line drugstore shelves, but are they a good choice?

Published: January 2014

Pills aren't the only way to relieve minor aches and pains. A slew of over-the-counter patches, foams, sticks, sprays, and roll-on pain relievers (known as topicals) promise to relieve your minor aches and pains. But is a topical treatment right for you?

If you suffer from back or muscle strain, or joint pain from osteoarthritis, these topical treatments might provide an alternative to swallowing acetaminophen (Tylenol), aspirin, ibuprofen (Advil), or naproxen (Aleve). Though there are lots of new products on the market, some of the drugs found in them have been around for decades. But there isn’t a ton of current research about how well they work. A few studies suggest that they can offer relief for some people, and other studies have shown they may not help at all. If you are in pain and are curious about trying one of the topicals out there, read on to find out what you need to know based on the latest research.

What’s in them?

Common ingredients include menthol, camphor, capsaicin (found in chili peppers), and methyl salicylate (oil of wintergreen). Some of the products are claimed to have a heating or cooling effect. The ones with capsicum or methyl salicylate create a feeling of heat, and the ones containing menthol cause a cooling sensation. Those ingredients are called counterirritants. They work in an odd way—the active ingredients actually inflame the area near the pain point, and that stimulates the nerves and creates a new, milder sensation. So essentially they are distracting you from the more intense pain you’re trying to treat. Though no one is sure exactly how that works, one hypothesis is that in some cases the drugs may increase blood flow to the area.

Good for chronic pain?

Your doctor may recommend a prescription topical pain reliever. Diclofenac gel (Voltaren), drops (Pennsaid), and patches (Flector) are all NSAIDs—nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen.

Topical NSAIDs may be a good choice if youu're at risk of heart attack or stroke because they allow lower levels of the drug to enter the body than with a pill. (NSAID pills may put you at higher risk of those problems.) Studies suggest that topical treatments also may cause fewer instances of internal bleeding than do NSAID pills. But more studies are needed to confirm that.

Best time for use?

Topical painkillers can be used a day or so after a minor muscle injury, with your doctor’s OK.

The first thing to do after such an injury is follow the RICE formula: Rest, Ice, Compression, and Elevation. Here’s how: First, rest the injured body part. Ice the area four times a day, for 10 to 15 minutes, for one to three days. Then compress the area by wrapping it with an elastic bandage. To lessen swelling, elevate the injury, if you can, above your heart for a few hours a day.

Once the swelling is gone, after 48 hours, switch to heat. Use a warm compress, heating pad, or hot-water bottle to improve blood flow and help remove old blood from the area.

When to avoid

Never use a heating pad after you’ve applied a topical product because that combination can increase your risk of burns, according to our medical advisers. The Food and Drug Administration warned about that last year.

Also, don’t apply topicals containing methyl salicylate before you exercise because your body could wind up absorbing too much of the active ingredient, presumably because exercising increases your circulation.

What are the risks?

Always follow label instructions because topicals can come with some risks. For example, using topicals too often or leaving them on too long can make your skin prone to allergic reactions.

If the patch you’re wearing begins to burn or itch, or your skin turns red, stop using the product and check with your doctor. That applies even if you’ve used the same product without a problem in the past.

To minimize your risks, don’t use topicals on any areas of the body where you have an open wound or broken skin, even a scratch. And never cover the area with bandages.

The FDA has said that dozens of people have experienced mild to severe chemical burns from the use of some topical pain relievers. If you find that none of the topicals you try helps to relieve your pain, don’t simply use more, thinking that more is better. Overdoing it could put you at a greater risk of burns.

Who should not take them?

It’s hard to predict who might have a bad reaction, but here is a standard caution: Pregnant women, infants, children, senior citizens, and people with sensitive skin may be at higher risk for problems.

Also, if you regularly take aspirin or prescription blood thinners such as warfarin (Coumadin), or you have a history of gastrointestinal bleeding, talk to your doctor before using any treatments containing salicylates. Those ingredients can also thin your blood and either cause bleeding or make it worse.

Pain-relieving powders

Another alternative is swallowing a drug in powder form. Well-known OTC brands are Goody’s (which contains acetaminophen, aspirin, and caffeine) and UrgentRx Ache and Pain (with aspirin and caffeine). Some are flavorless, and some are fruit flavored.

You pour Goody’s powders onto your tongue and chase with a liquid. With UrgentRx you simply pour the powder into your mouth—no liquid needed. (These products are meant only for people over the age of 12; keep them away from younger children.)

Both powders are claimed to work quickly to treat headaches, aches and pains, and other ailments. And they may act faster than some tablets, which need more time to dissolve in your stomach before they can get to work.

Powders aren’t all that popular, though. “Powders are messier and must be carefully packaged to avoid moisture,” says Barbara Young, Pharm.D., editor of consumer-medication information for the American Society of Health-System Pharmacists. But powder pain relievers may be worth trying if you or someone in your household has trouble swallowing pills.

More patch alternatives

In addition to patches, you can find lots of other topical pain treatments, including creams, gels, foams, and roll-ons. To find the one that might help your particular pain, you may need to experiment with a few different products. (A couple of cautions: Let products dry before you get dressed to avoid stains, and always wash your hands after rubbing them in.)

Creams are usually less greasy than ointments and easier to wash off hands.

Examples: Tiger Balm Neck & Shoulder Rub, $8, Capzasin HP, $14, and Zostrix Hot & Cold Therapy System, $19.

Foams are like shaving cream or hair mousse; they spread more easily than creams.


Example: Salonpas Pain Relieving Massage Foam, $9.

Gels are usually less greasy or sticky but may dry out your skin if the product is alcohol-based. Also, they may be easier to apply to hairy areas than cream.

Examples: BenGay Zero Degrees, $11, and Icy Hot Pain Relieving Gel, $7.

Roll-ons can go on wet and are easy to apply to your skin, especially if you don’t like the feel of creams or gels on your fingers.

Examples: Aspercreme Max, $6, and JointFlex Ice, $12.

Sprays also go on wet but are usually quick drying. They’re ideal for hitting hard-to-reach spots, such as your back.

Example: Salonpas Pain Relieving Jet Spray, $10.

Sticks go on just like solid deodorant and are easy to carry with you and apply.


Example: Icy Hot Chill Stick, $5.

Editor's Note:

This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin). The aricle was adapted from the November 2013 issue of ShopSmart magazine.

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