Increasing evidence suggests topical analgesics are as effective – and safer – than over-the-counter pain medications for treating chronic musculoskeletal pain, fibromyalgia, headaches and peripheral neuropathy.

Physicians around the world have used naturally occurring substances to decrease pain for hundreds of years. The two main ingredients used for pain relief are capsaicin and menthol. These active ingredients most commonly are found in pain-relieving creams and gels, but also can be applied with roll-ons or sprays. Capsaicin is the hot substance in chili peppers, while menthol is the cool substance in peppermint oil. Menthol is a common ingredient in many products we use daily, such as toothpaste, chewing gum and mouthwash. When applied to the skin, these ingredients are used as “topical analgesics.” This means they decrease the sensation of pain when applied to the skin.

Mechanism of Action

Traditionally, it was thought that these substances reduced pain through a “counter-irritant” mechanism. It’s important to remember that the perception of pain essentially is a message sent from parts of the body into the brain, so we feel the sensation of pain. The counter-irritant theory was based on the active ingredient actually “irritating” the skin to create a reaction that cancelled out the pain signal before it reached the brain. Essentially, this skin irritation would stimulate certain nerve fibers (larger-sized nerve fibers) that would send more information than the smaller-sized nerve fibers carrying the pain signals, essentially blocking the pain signal from reaching the brain. This is known as the gate-control theory and is a commonly held view of pain relief.

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