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Topical pain relievers vs oral painkillers: what works best?
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Topical pain relievers vs oral painkillers: what works best?

Both topical pain relievers and oral painkiller provide relief, but they work differently. Here is how you can pick the one which suits the purpose

Topical pain relievers show quicker reactions than oral painkillers, but their result is short-term

We have our go-to means when pain strikes. But the dilemma remains at times: should you apply some topical pain reliever like ointment/gel/spray over it to get relief or pop an oral painkiller?

If it is bearable pain and one knows the exact cause of it, then it would be easy to decide which pain reliever would work. But if the pain is unendurable, then do consult a medical professional.

How topical pain relievers work

As the name suggests, topical pain relievers are applied to the skin. If there is pain and/or swelling externally, then a pain relief spray, gel, ointment or patches can be used to alleviate the pain.

“The contents of a topical pain reliever are different, and each content has a different mechanism of action,” says Dr Shobha Subramanian Itolikar, consultant, internal medicine, Fortis Hospital, Mumbai. “For a long time, we have been using the wintergreen oil that is a salicylate. Another commonly used content is menthol. Capsaicin-based and the conventional NSAID [non-steroidal anti-inflammatory drug] topical pain killers like diclofenac or nimesulide are also used.”

Most topical pain relievers work by diverting the focus of the individual. Methyl salicylate works as a counter-irritant. When applied, it provides a pleasant feeling on the skin and thus diverts the focus of the individual from the pain in the subcutaneous tissue or musculoskeletal region to the skin. Some topical pain relievers also change the temperature of the skin, thereby changing the focus of the individual from the pain to a feel-good stimulus. This is pain modulation. But they are neither very long-lasting nor very effective. This is where topical NSAIDs come in, where diclofenac was used in the form of gels or sprays.

“The pain relievers that contain capsaicin and methyl salicylate block the release of neuropeptides [chemical molecules that are involved in the formation, transmission, modulation and perception of pain] at the peripheral nerve endings,” adds Dr Snehal Panchal, a pain management specialist from Mumbai.

Oral painkillers 

Oral painkillers are medicines taken in the form of tablets or syrups. They contain non-steroidal anti-inflammatory drugs like diclofenac, aceclofenac and ibuprofen. Each comes with side effects though.

“At the site of inflammation, pain is felt because of the inflammatory cytokines that are released,” says Itolikar. “So, when NSAID painkillers are taken orally, they are absorbed from the gut, they reach the site of pain, they reduce the inflammatory cytokines and that is how they provide relief from the pain.”

Topical vs oral: effects and side effects

Both types of pain medications – topical pain relievers and oral painkillers – have advantages and disadvantages as well.

“Topical pain relievers show quicker reactions compared to oral pain killers, buts its result is short term,” says Itolikar. “They are also target specific and have lesser side-effects comparatively. Topical doesn’t mean that it is not absorbed from the skin, it can be adsorbed, especially with the application of heat, because the vascularity or the blood supply to that area is increased. So, when we give a non-steroidal anti-inflammatory drug, it can get absorbed in the system causing renal worsening in individuals with renal failure.”

Topical pain relievers also show erratic adsorption, so it is difficult to predict the reduction in pain. Capsaicin causes burning and skin irritation in some individuals.

“The advantage of oral medications is that you can predict the reduction in pain. It can be given in acute trauma cases like fracture, etc.,” says Dr Panchal. “Disadvantages is that side effects like gastritis can precipitate renal failure in patients with compromised renal function or if consumed for longer periods, it can precipitate asthma in susceptible individuals.”

When to use which painkiller

A wise way to decide whether a topical pain reliever would work, or an oral pain killer is required is by getting to the root of the problem. Understanding the cause of pain is very crucial.

“If the pain is localised and superficial without any breach in the continuity of the skin, then topical applications are suggested,” says Dr Panchal. “If it is generalised pain or localised with breach or lot of edema or very deep-seated region, then oral medications are preferred.”

Takeaways

  • Topical pain relievers are gels, sprays, ointments or patches that are applied to the skin. Oral painkillers are taken orally either in the form of syrups, tablets or capsules.
  • Oral medications show a more predictable reduction in pain and can be given in acute trauma cases like fractures. But it has side effects as well.
  • Topical pain relievers show quicker reactions than oral painkillers, but their result is short-term.

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