Topical analgesics for treatment of superficial painful conditions

Topical analgesic	Usual dose (adult)	Characteristics
Topical nonsteroidal antiinflammatory drugs (NSAIDs)*
Diclofenac topical gel (1%)	Knees: Rub in 4 g of gel to affected knee(s) three to four times daily. Hands: Rub in 2 g of gel to affected joint(s) three to four times daily. Maximum 16 g per joint per day; 32 g total per day.	Applies to all topically administered NSAIDs: Useful for treatment of musculoskeletal pain and osteoarthritis of superficial joints (eg, wrist, knee, hand) as an alternative to systemic therapy Minimal systemic absorption Safety data are reassuring despite label warnings on United States products Local skin reactions include rash, itch, or burning (some products contain propylene glycol, a potential irritant and rarely an allergen) Refer to topic review on initial pharmacologic therapy of osteoarthritis
Diclofenac topical patch (1.3%)	Apply one patch to most painful area one to two times daily (refer to product-specific instructions).
Diclofenac topical solution drops (1.5%)	Knees: Rub in 40 drops to affected knee(s) up to four times daily.
Diclofenac topical solution pump (2%)	Knees: Rub in two pump actions to affected knee(s) up to two times daily.
Ibuprofen topical gel (5, 10%); not available in United States	Knees or hands: Rub in dose (depends on joint size and location) up to four times daily; refer to product-specific information for detail.
Ketoprofen topical gel (2.5%); not available in United States	Knees or hands: Rub in 2 to 4 g of gel two to four times daily (maximum 15 g of gel per day); refer to product-specific information for detail.
Topical capsaicin^¶
Capsaicin creams, gels, liquids, or lotions (0.025 to 0.1%)	Rub in a small amount (pea sized) one to four times daily; the preparation most often studied in osteoarthritis was 0.025% cream.	Useful for treatment of osteoarthritis pain and postherpetic neuralgia as an adjunct or alternative to systemic analgesics Local irritation may be intolerable Refer to topic review on initial pharmacologic therapy of osteoarthritis
Capsaicin topical patches (0.025 to 0.05%)	Apply one patch to affected area for up to eight hours (maximum four patches per day).
Capsaicin topical patch (high concentration 8%)	Postherpetic neuralgia (single treatment): Apply up to four patches to the most painful area for 60 minutes. Treatment may be repeated after three months.	Potential option for local pain relief in postherpetic neuralgia High-concentration patch must be administered by a health care professional and monitored for up to two hours after treatment Pretreatment with a local anesthetic (eg, lidocaine) is necessary After application, local cooling measures can decrease discomfort Local pain and irritation may be intolerable Refer to topic review on postherpetic neuralgia
Topical lidocaine
Lidocaine topical patch (5%)	One to three patches applied for up to 12 hours in any 24-hour period.	Low (3 to 5%) systemic absorption through intact skin Useful for local relief of pain (eg, due to postherpetic neuralgia) in limited areas of intact skin as an adjunct or alternative to systemic analgesics
Lidocaine topical creams, ointments, and gels (2 to 4%)	Apply a thin film two to four times daily (refer to product-specific instructions).	Useful for local relief of minor superficial skin irritation and pain
Lidocaine topical cream (5%)	Apply a thin film three to four times daily (maximum six times daily).	Useful for local relief of anorectal pain and itching

Topical analgesic therapies are moderately effective and useful in combination with systemic therapies for reducing medication load and side effects, and potentially, as monotherapy for adults with localized pain and contraindications to systemic therapies.

* For patients already on oral NSAIDs, topical therapies are generally not recommended because they are unlikely to provide additional pain relief. Gel measurements from tubes are approximate.

¶ Pain relief usually begins within the first week of treatment, and full effect is seen with regular application over approximately four weeks. Topical capsaicin should not come in contact with mucous membranes, abraded skin, eyes, or genital areas.

Data from: Lexicomp Online (Lexi-Interact). Copyright © 1978-2024 Lexicomp, Inc. All Rights Reserved and The electronic Medicines Compendium (eMC) DataPharm Ltd. Surrey United Kingdom (https://www.medicines.org.uk/emc/).

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Topical analgesics for treatment of superficial painful conditions