Use it for common pains such as lower back pain, stiff shoulders, and bruises
- H.Kitaoka
- Jan 20
- 9 min read
Understanding the basics of topical analgesics and anti-inflammatory drugs
How to use topical analgesics and anti-inflammatory drugs, as well as precautions specific to OTC drugs, including side effects
The benefits of choosing topical analgesics and anti-inflammatory medications
Currently, there are many highly effective topical analgesic and anti-inflammatory drugs available for self-medication.
The main benefits of choosing topical analgesics and anti-inflammatory medications include: 1) avoiding waiting times at crowded hospitals, and 2) a wide variety of dosage forms and shapes available, allowing users to choose according to their situation and preferences.
Identifying musculoskeletal pain characteristics
There are also cases that require urgent treatment, such as radiating pain and appendicitis.
We will clarify when it is okay to treat topical analgesics and anti-inflammatory drugs yourself and when you should see a doctor.
The following cases are considered to be cases where a medical consultation is recommended:
Pain even when resting・Feeling vague pain over a wide area. Pressing the painful area does not increase the pain (radiating pain).Numbness in the legs or buttocks. Be especially careful if you experience numbness like a bicycle saddle (possibility of neurological symptoms due to spinal cord compression).- Electric shock/stinging, burning pain (neuropathic pain)- Pain does not improve over time (e.g., acute lower back pain usually improves naturally in about 50% of cases within one week and about 80% within two weeks)
Generally, if topical analgesics and anti-inflammatory medications are not effective within 5 to 6 days, we recommend that you see a doctor. Musculoskeletal pain such as sprains, strains, and bruises that are effective with topical analgesics and anti-inflammatory medications have three characteristics: 1) the pain is clearly located, 2) the pain is relieved by resting, and 3) the pain improves over time.
If you experience constant pain even when resting or sleeping, pain that gradually worsens, or pain that fluctuates and gets stronger then weaker, it is unlikely that the pain is musculoskeletal and you should be advised to see a doctor.
"Radiating pain," a type of pain that warrants a medical examination, is when there is vague pain over a wide area, and pressing on the painful area does not cause any pain. The location of the pain may change, such as when a person complains of pain around the teeth or jaw one day and then shoulder pain the next. Myocardial infarction is a well-known disease that causes radiating pain, but some people experience pain only in the left shoulder or around the left molars, rather than chest pain.
In other cases, visceral diseases such as appendicitis are mistaken for lower back pain. Visceral diseases are clearly different from musculoskeletal pain in that the pain persists even when you are resting. Lumbar disc herniation and neuropathic pain are characterized by numbness. Topical analgesics and anti-inflammatory medications are ineffective against numbness. It is important to understand the characteristics of musculoskeletal pain mentioned above so that you can determine whether or not the condition warrants the use of topical analgesics and anti-inflammatory medications.
risk
Use by anyone other than the purchaser, or use after a certain period of time has passed since purchase
Keep the following usage characteristics in mind:
1) The purchaser and user may be different
It is common for cases to occur such as "A businessman in his 50s purchased a topical diclofenac medication. He thought there was no need to worry about exposure to direct sunlight, but the person using it was his child, who was on the high school swimming team," or "A young man purchased a loxoprofen tape, but the person actually using it was his pregnant wife." As a household medicine, it is necessary to consider the possibility that not only the purchaser but also family members living with the purchaser may use it.
2) Any remaining medicine is stored and reused when needed.
There have been cases where people who work outdoors or athletes have purchased topical NSAIDs in the winter and used the remaining ones in the summer, resulting in photosensitivity. It is important to provide information that takes into account not only the time of purchase, but also when and who may use them.
It's possible that a person may have purchased a topical medication, saved the remaining medicine after the pain subsided, and then had the pain return, leading to the use of the remaining medicine. Even in winter, it's important to be aware of the risk of photosensitivity.In this way, we take into consideration background factors such as family structure, occupation, hobbies, and lifestyle habits, and by conducting interviews as necessary, we can introduce appropriate products and advise caution when purchasing.
How to use oral and topical medications
For those with weak stomachs or kidneys, topical medications are recommended.
There are oral and topical analgesic and anti-inflammatory medications, but there is not much difference in the analgesic effect between the two. There is no problem in choosing the one that is easiest for the user, but generally, topical medications are recommended for people with sensitive stomachs, and oral medications for people with sensitive skin.For example, elderly people often have impaired internal organ function, such as the stomach and kidneys, so topical medications are often safer to use. On the other hand, for people with atopic dermatitis, topical medications can be hazardous to the skin, so oral medications are a higher priority.
Generally, I do not recommend using oral and topical OTC analgesics and anti-inflammatory medications together. As mentioned above, topical medications are gentle on the stomach, while oral medications are gentle on the skin, and each has its own benefits, so using both will negate the benefits of both. However, there is nothing in the package insert that prohibits this combination, so those who wish to use them together should be advised to "only do so when absolutely necessary."
Characteristics of each dosage form of patches and ointments
Choose your preferred hot or cold sensation
When it comes to determining which topical analgesic and anti-inflammatory drug to use, which is a patch or an ointment, which is best, we will first determine the advantages and disadvantages of each of the main dosage forms.Table 1is shown.In addition to the difference in dosage form, there are also "warming" and "cooling" types. The warming type is thought to be used for "chronic pain or pain that worsens with cold," while the cooling type is thought to be used for "acute pain or pain accompanied by swelling." However, there is no clear difference in effectiveness between the cooling and warming types, so it generally does not matter which one you use. If you are suffering from pain, use the one that feels most comfortable.
Table 1: Characteristics of the dosage forms of major topical analgesics and anti-inflammatory drugs
[Patch] Poultice
Advantages: A familiar, so-called "poultice." Many people like the cool, refreshing sensation of applying it.
Disadvantages: The adhesive part is noticeable and peels off easily
Suitable for: fever, muscle pain, areas with wide range of movement such as the lower back and back
[Patch] Plaster (tape)
Advantages: Thin, stretchy and adhesive, inconspicuous
Disadvantages: It puts a lot of strain on the skin when applying and removing.
Suitable for: joints and other parts that move frequently
[Topical ointment] Aerosol
Advantages: Spray can instantly cool a wide area.
Disadvantages: Risk of frostbite due to continuous spraying, high price
Suitable for: sports injuries and cooling down
[Topical ointment] Cream
Advantages: Can be applied while massaging
Cons: A little sticky
Suitable for: Muscle tension and stiffness
[Topical ointment] Gel
Pros: Not too sticky
Disadvantages: Remains on the skin surface, may cause irritation
Suitable for: When ease of use is a priority
[Ointment] Liquid
Advantages: Easy to apply over a wide area
Disadvantages: May cause irritation, easily comes off due to sweat
Suitable for: Wide-area use
[Topical ointment] Tick
Advantages: Can be applied without getting your hands dirty
Disadvantages: May be bulky
Suitable use scenarios: When you don't want to get your hands dirty, or when applying to areas that are difficult to reach with your hands
How to use NSAIDs
The main characteristics of NSAIDs used in OTC topical analgesics and anti-inflammatory drugs are as follows:Table 2I have summarized it below.Considering the common sense of their characteristics, my first choice of medication is a salicylic acid product. For reasons such as "the least concern about side effects (low risk of aspirin asthma and photosensitivity)," "no age restrictions or precautions regarding pregnancy, so the whole family can use them," "the analgesic effect is slightly weaker than other NSAIDs, but it still has a certain degree of effectiveness," and "good cost performance," I think they are extremely easy to use for everyday use, such as for stiff necks, minor back pain, and stiff shoulders.
On the other hand, if you want to deal with the pain quickly, such as when you want to relieve the pain immediately or when the pain will interfere with your work tomorrow, we recommend NSAIDs other than salicylic acid. Among these, if you are concerned about photosensitivity, we recommend oral medication.
Table 2 Characteristics of NSAIDs used as topical analgesics and anti-inflammatory drugs for over-the-counter use
Diclofenac
Compared to other NSAIDs, it has a slightly stronger analgesic effect.
Children: Not suitable for those under 15 years of age
Pregnant women: Cannot be used if there is a possibility of pregnancy
Risk of photosensitivity: Risk of photosensitivity has been noted (it is best to avoid use if there is a possibility of exposure to direct sunlight)
Product examples
Ketoprofen
Features: Ingredients of the popular "Morasupap/Tape"
Children: Not suitable for those under 15 years of age
Pregnant women: Cannot be used if there is a possibility of pregnancy
Risk of photosensitivity: There have been many reports of photosensitivity (it is best to avoid use if there is a possibility of exposure to direct sunlight)
Product examples
Felbinac
Children: Not suitable for those under 15 years of age
Pregnant women: Cannot be used if there is a possibility of pregnancy
Risk of photosensitivity: Not mentioned in the package insert (however, as with other products, photosensitivity has been reported, so measures are necessary)
Product examples
Indomethacin
Special features: Some products can be used by children aged 11 and over.
Pregnant women: Cannot be used if there is a possibility of pregnancy
Risk of photosensitivity: Not mentioned in the package insert (however, as with other products, photosensitivity has been reported, so measures are necessary)
Product examples
Loxoprofen
Characteristics: Highly recognized
Children: Not suitable for those under 15 years of age
Pregnant women: Cannot be used if there is a possibility of pregnancy
Risk of photosensitivity: Not mentioned in the package insert (however, as with other products, photosensitivity has been reported, so measures are necessary)
Product examples
Methyl/Glycol Salicylate
Characteristics: Its analgesic effect is weaker than other NSAIDs, but it can be used with almost no side effects.
Children: No restrictions on use
Pregnant women: There is a possibility of pregnancy. No warnings or other information is provided.
Risk of photosensitivity: Not mentioned in the package insert (no reports of photosensitivity)
Product examples
Two side effects to be aware of and how to deal with them
1) Contact dermatitis
The most common side effect of patch medications is what is commonly known as a "rash." Because topical analgesics and anti-inflammatory medications are applied continuously in the same place, rashes are often inevitable.The following are some ways to deal with rashes:If the rash is only slightly red, and you are using a plaster, switch to a poultice, which is less irritating when removed.Switching from patches to topical medications such as creams or gels, or oral medications
2) Photosensitivity (photosensitive dermatitis caused by topical medications)
The ingredients in the medication react with ultraviolet light, causing itching, redness, and a rash on the skin. Usually, when a person using a patch develops photosensitivity, the skin becomes red, just like the shape of the patch. However, if the symptoms become severe, the allergic reaction may affect the entire body.
To prevent photosensitivity, the basic rule is to avoid exposing the area where the medication is applied or applied to direct sunlight. Furthermore, there have been cases of photosensitivity developing four weeks after stopping use of the medication, so you should be careful not to expose the area to sunlight for about four weeks after stopping use. If this is difficult to do, we recommend using salicylic acid-based medications or oral medications.
Usability of patch medication
What influences the experience?
Although the effects of topical analgesics and anti-inflammatory drugs vary slightly depending on the ingredients, they are generally similar, so when choosing one, you should place more emphasis on the "feel" and "ease of use."We will look at several usability factors.
1) AdhesionPreferences may differ depending on whether the product is easy to peel or difficult to peel, or whether it is easy to cause a rash or difficult to cause a rash. Those with strong skin will prioritize products that do not peel easily, while those with sensitive skin will prefer products that do not cause a rash, so the products introduced for each group will be polar opposites.
2) Ease of peeling off films from the adhesive surfaceSome products have a film on the adhesive surface that is difficult to remove. It is important to look for a product that is easy to handle; just pull both ends slightly, bend it, and line up the notches to easily remove the film.
3) SmellSome poultices have a strong, distinctive smell, so if you choose a cheap one, you may end up with one with a strong smell, so you should be careful.
4) Zipper part of the package (opening)Some research papers have shown that the difficulty of opening the zipper on the package also affects the evaluation of ease of use. If the zipper does not close properly, the smell of the patch will transfer to surrounding items. Storing other medications nearby can cause irritation when using the medication, so care must be taken.
Understanding what ease of use patients value is also an important factor when introducing products.
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