Pain Relief Gels and Creams: What Works and When

Walk into any home in Odisha and you will find at least one tube of pain-relief gel or balm on the shelf. People rub it on aching knees, stiff necks and sprained ankles. But do these creams actually work? Which one should you choose? And are they completely safe?

As an orthopaedic surgeon, I get these questions every week. Here is an evidence-based guide to topical pain relief: what works, for which pain, and how to use it properly.

Where pain-relief gels work best (knee and hand arthritis, sprains and strains) and where they help less (hip, back, nerve pain, widespread pain) Gels help most Gels help less ✓ Knee arthritis ✓ Hand and finger arthritis ✓ Sprains and strains ✓ Tendon pain near the skin ✗ Hip joint (too deep) ✗ Long-standing back pain ✗ Nerve pain, sciatica ✗ Pain all over the body Joint close to the surface Deep or widespread pain
Pain-relief gels work best on joints and tendons close to the skin. Illustration: JointVibes.
Infographic comparing topical pain relief types: NSAID gels, capsaicin, lidocaine and cooling rubs

What is topical pain relief?

Topical treatments are gels, creams, sprays, balms and patches applied on the skin over the painful area. The medicine acts locally, so much less of it reaches the bloodstream than with tablets. That makes topicals especially useful for older people, and for those with stomach, kidney or heart problems who should limit painkiller tablets.

The main types, and what each is good for

1. Topical NSAIDs (diclofenac, ibuprofen, ketoprofen and others)
These are anti-inflammatory painkillers in gel or spray form. They have the best evidence among topicals, particularly for knee and hand osteoarthritis and for recent sprains and strains. Guidelines such as NICE recommend a topical NSAID as an early option for knee osteoarthritis, alongside exercise. They work best for joints close to the skin (knee, hand, elbow, ankle) and less well for deep joints like the hip or spine.

2. Counter-irritants (menthol, camphor, methyl salicylate, eucalyptus)
These are the familiar cooling or warming balms. They create a sensation on the skin that distracts the brain from pain. They give short-term comfort for muscle aches but do not treat inflammation.

3. Capsaicin (from chilli pepper)
With regular use, capsaicin reduces the pain signals from nerve endings. It can help some people with osteoarthritis and nerve pain, but it burns at first and must be used regularly for two to four weeks before judging the result.

4. Lidocaine (local anaesthetic) patches or creams
These numb the area and are mainly used for certain nerve pains, such as pain after shingles.

5. Herbal and Ayurvedic preparations
Many contain counter-irritants. Some people find them soothing, but the quality of evidence is generally limited.

Which pain responds best?

  • Knee osteoarthritis: topical NSAID plus a strengthening exercise programme. See Why Doesn't My Doctor Just Send Me to Physio?
  • Hand osteoarthritis: topical NSAID
  • Recent sprains and muscle strains: topical NSAID for a few days, with rest and ice in the first 48 hours
  • Tennis elbow and tendon pain: topical NSAID can help in the short term
  • Deep back or hip pain: limited benefit; exercise and other treatment matter more
  • Nerve pain: capsaicin or lidocaine in selected cases

How to apply correctly

  • Use the amount on the label, usually a strip of a few centimetres, rubbed gently until absorbed
  • Most NSAID gels are used three to four times a day
  • Wash your hands afterwards (unless you are treating the hands), and keep away from the eyes
  • Do not apply on cuts, wounds, rashes or broken skin
  • Do not cover with a tight bandage or use a heating pad over the cream; this increases absorption and can burn the skin
  • Give a fair trial of one to two weeks, then review with your doctor if there is no benefit

Safety: topicals are safer, not risk-free

  • Skin redness, itching or rash can occur; stop if it does
  • Ketoprofen gel can cause a reaction on sun exposure; keep the area covered from sunlight
  • People allergic to aspirin or NSAIDs, and those with asthma triggered by these drugs, should check with a doctor
  • Avoid NSAID gels in the last three months of pregnancy unless your doctor advises otherwise
  • Methyl salicylate (wintergreen) balms can be poisonous if swallowed; keep all balms away from children
  • Do not use a topical NSAID together with NSAID tablets unless prescribed

When a cream is not enough

A gel can ease pain, but it does not fix the cause. See a doctor if pain lasts more than a few weeks, follows an injury with swelling or inability to bear weight, wakes you at night, or comes with fever, a hot red joint, numbness or weakness. For knee pain specifically, read Causes of Pain While Bending the Knee. If you are interested in injection treatments, see Orthobiologics: Myths vs Facts.

The takeaway

Topical NSAID gels are a useful, relatively safe first step for pain in joints close to the skin, especially knee and hand osteoarthritis and recent sprains. Balms give short comfort; capsaicin and lidocaine help selected nerve pains. Use them correctly, never on broken skin or under heat, and combine them with exercise and proper diagnosis for lasting relief.

If joint pain is limiting your daily life, consult an orthopaedic doctor. Patients in Cuttack, Banki, Bhubaneswar and nearby parts of Odisha are welcome to consult me.

Related reading on JointVibes

Frequently asked questions

Are pain-relief gels safer than tablets?
Generally yes, because much less medicine reaches the bloodstream. This matters for people with stomach, kidney or heart concerns.

Can I use a gel every day for months?
Many people use them long-term for arthritis under medical guidance. Review regularly with your doctor.

Hot or cold balm: which is better?
Cold (menthol) is often preferred for fresh injuries; warming balms suit chronic muscle stiffness. Neither treats the underlying cause.

References

  1. National Institute for Health and Care Excellence (NICE). Osteoarthritis in over 16s: diagnosis and management (NG226). 2022. nice.org.uk/guidance/ng226
  2. Derry S, Wiffen PJ, Kalso EA, et al. Topical analgesics for acute and chronic pain in adults – an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017;5(5):CD008609. doi:10.1002/14651858.CD008609.pub2

Disclaimer: This article is for patient education only and does not replace a consultation. Read the label and consult your doctor or pharmacist before use.

About the author

Dr Markandaiya Acharya, MBBS, MS (Orthopaedics) is an orthopaedic surgeon in Cuttack, Odisha (OCMR Reg. No. 22788). He treats trauma, knee and sports injuries, arthritis and limb deformities.

Consultation (by appointment only)
  • Surya Clinic, Cuttack – Monday 10 am–12 noon; Saturday 2–4 pm
  • Nandan Plus, opposite Police Station, Narsinghpur – every Wednesday, 10 am–1 pm
  • Pushpalata Medicine Store, Sunapala – every Wednesday, 3–5 pm
  • Shreelaxmi Medicine Store, Bisoi, Mayurbhanj – first Sunday of every month, 10 am–2 pm
For an appointment, message on WhatsApp: +91 87637 16547

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