Burn risk from topical pain relievers

When you’re in pain, a dose of warming heat or cooling relief can help take the edge off. However, over-the-counter topical products can sometimes do more harm than good. Reports of severe reactions involving these products has prompted the U.S. Food and Drug Administration (FDA) to issue a warning about safe use.

While the problem isn’t widespread, any adverse reaction to a product is cause for concern. During a surveillance of its adverse event reporting database, the FDA uncovered 43 reported cases of adverse reactions to brand name products such as Icy Hot, Bengay, Capzasin, Flexall and Mentholatum. Severe burns and blistering typically happened within 24 hours, resulting in second- and third-degree burns. In many cases, the burns occurred with just one application of the product — and a handful of cases were so serious they required hospitalization.

The culprits: the active ingredients in those creams, gels and patches including menthol, methyl salicylate and capsaicin. Most of the reactions involved products that used a combination of menthol and methyl salicylate in high concentrations (greater than 3 per cent menthol or 10 per cent methyl salicylate). Despite the “burning” sensation you feel eating chili peppers, capsaicin wasn’t involved in most of the cases.

Sounds troubling? The FDA notes that compared to the number of people who use these products, the number of reactions is quite small. Still, they want consumers and health care professionals to be aware of the issue.

“There’s no way to predict who will have this kind of reaction to a topical pain reliever for muscles and joints,” says Jane Filie, M.D., a medical officer in FDA’s Division of Nonprescription Regulation Development (DNRD), in a consumer alert.

The message from the FDA isn’t that people should stop using these products. Instead, the organization warns that people should take a few precautions — and seek medical attention immediately if a reaction does occur.

How to safely use topical pain relievers

Here are some tips from the FDA to help reduce the risk of adverse reactions:

– If you have any concerns about using these products, talk to your doctor or pharmacist before trying them.

– Avoid using the products on damaged, broken or inflamed skin. These products should never be applied to wounds.

– Don’t add extra heat. Using topical pain killers at the same time as hot water bottles, heat lamps and heating pads increases the risk of burns.

– Keep the area uncovered. Don’t wrap the treated area with bandages as they can trap heat.

– Keep the products away from mucous membranes. As with other topical products, you’ll want to avoid using them around the inside of the nose, mouth and genitals.

– Exercise caution when using alongside oral pain relievers. Though not cited in the FDA warning, experts warn that topical treatments containing anti-inflammatory medications count towards the daily dosage limit we shouldn’t exceed. In other words, if you’re taking the maximum does of ASA, using a cream that contains the medication can push you into overdose territory.

The FDA notes that topical pain relievers should feel warm or cool, but never painful. If you do experience burning or pain, experts say to check the area for burns. If you think you’re having a reaction, stop using the product and seek medical attention right away.