Expert Discusses Topical Analgesics as First-Line Treatment of Pain | APhA 2025
Jeffrey Gudin, MD, faculty in the department of anesthesiology and pain management at the University of Miami, said topical analgesics are safer alternatives to systemic medications.
Topical analgesics represent a promising and often underutilized approach to pain management, offering patients a targeted and safer alternative to systemic medications. Jeffrey Gudin, MD, faculty in the department of anesthesiology and pain management at the University of Miami, highlights the challenges of treating painful conditions, emphasizing that musculoskeletal and nerve injuries can be particularly difficult to address. Recent guidelines from the American College of Physicians and American Academy of Family Physicians now recommend topical analgesics as a first-line treatment for non-low back musculoskeletal pain, marking a significant shift in pain management strategies.
He explores the diverse range of topical analgesics available, including anti-inflammatory agents, local anesthetics, and heat-producing compounds like capsaicin and menthol. These products offer distinct advantages, primarily their ability to target specific pain areas with minimal systemic exposure. Gudin notes that topical treatments typically have blood concentration levels of 1/20 to 1/100 of oral medications, significantly reducing potential adverse effects. Pharmacists play a crucial role in guiding patients through product selection, understanding that pain relief often requires a trial-and-error approach.
A key takeaway is the importance of multi-modal analgesia, which involves using smaller doses of different medications to maximize pain relief while minimizing adverse effects. This approach extends beyond medication, incorporating physical therapy, occupational therapy, behavioral strategies, and sleep modification. Gudin emphasizes that patients should not become discouraged if one topical analgesic doesn't work, but instead try alternative formulations. The primary goal is to reduce reliance on oral medications, particularly opioids, by providing targeted, effective pain management that prioritizes patient safety and comfort.
"The treatment of painful conditions can be very challenging. We have different types of pain, acute pain and chronic pain, and different causes for pain, musculoskeletal injuries and nerve injuries of the sort, and it's very difficult for patients," Gudin said. "We have over-the-counter acetaminophen, we have aspirin and nonsteroidal products, and topical analgesics are used all over the world to treat things like musculoskeletal and nerve pain conditions."
