Using Topical Pain Relievers First When Treating Certain Injuries

Using Topical Pain Relievers First When Treating Certain Injuries

Musculoskeletal injuries – like those that impact the ankle, neck, and knee – are common and lead to many visits to the emergency room (ER) or doctor’s office. In fact, 15% of all ER visits and three out of four injuries treated in doctors’ offices are musculoskeletal injuries. While these injuries rarely require hospitalization, doctors know they can seriously impact patients’ lives.

Recently, two of the largest doctors’ societies in the United States – the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) – released new guidance recommending the use of over-the-counter (OTC) topical nonsteroidal anti-inflammatory drugs (NSAIDS) pain relievers as a first-line therapy for treating acute, non-low back pain from musculoskeletal injuries in outpatient settings. These recommendations are on the heels of the Centers for Disease Control and Prevention (CDC)’s guidance to healthcare professionals to treat patients with topical pain relievers first.

In their guidance published in Annals of Internal Medicine, the ACP and AAFP recommend that physicians treat acute pain from non-low musculoskeletal injuries with topical NSAIDS, with or without menthol gel, as a first-line therapy. As a physician with over four decades of experience in medicine, I applaud ACP and AAFP’s new ‘topical first’ recommendation to provide people in pain with clinically proven OTC topical NSAID pain relievers.

In 2010 alone, musculoskeletal injuries accounted for more than 65 million healthcare visits. With rising costs of healthcare and the increasing awareness of the dangers of opioids, more doctors are turning to OTC topical NSAID pain relievers to treat pain resulting from such injuries. Topical NSAIDs are a safe and effective alternative to opioids and oral NSAID pain relievers.

Prescription opioid pain relievers are a leading cause of serious health complications. Additionally, taking too much of an oral OTC pain reliever that contains a NSAID can cause side effects, especially for people with heart disease and stomach trouble, that topical pain relievers do not.

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Using Topical Pain Relievers First When Treating Certain Injuries

Using Topical Pain Relievers First When Treating Certain Injuries

Using Topical Pain Relievers First When Treating Certain Injuries

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Bob Arnot, M.D.
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Bob Arnot, M.D.
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Musculoskeletal injuries – like those that impact the ankle, neck, and knee – are common and lead to many visits to the emergency room (ER) or doctor’s office. In fact, 15% of all ER visits and three out of four injuries treated in doctors’ offices are musculoskeletal injuries. While these injuries rarely require hospitalization, doctors know they can seriously impact patients’ lives.

Recently, two of the largest doctors’ societies in the United States – the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) – released new guidance recommending the use of over-the-counter (OTC) topical nonsteroidal anti-inflammatory drugs (NSAIDS) pain relievers as a first-line therapy for treating acute, non-low back pain from musculoskeletal injuries in outpatient settings. These recommendations are on the heels of the Centers for Disease Control and Prevention (CDC)’s guidance to healthcare professionals to treat patients with topical pain relievers first.

In their guidance published in Annals of Internal Medicine, the ACP and AAFP recommend that physicians treat acute pain from non-low musculoskeletal injuries with topical NSAIDS, with or without menthol gel, as a first-line therapy. As a physician with over four decades of experience in medicine, I applaud ACP and AAFP’s new ‘topical first’ recommendation to provide people in pain with clinically proven OTC topical NSAID pain relievers.

In 2010 alone, musculoskeletal injuries accounted for more than 65 million healthcare visits. With rising costs of healthcare and the increasing awareness of the dangers of opioids, more doctors are turning to OTC topical NSAID pain relievers to treat pain resulting from such injuries. Topical NSAIDs are a safe and effective alternative to opioids and oral NSAID pain relievers.

Prescription opioid pain relievers are a leading cause of serious health complications. Additionally, taking too much of an oral OTC pain reliever that contains a NSAID can cause side effects, especially for people with heart disease and stomach trouble, that topical pain relievers do not.

What You Need to Know About OTC Topical Pain Relievers

What does it mean to be topical? Topical pain relievers, or topicals, are applied directly onto the skin over painful muscles or joints. Although they are all designed to relieve pain, different products use different ingredients. Common ingredients include menthol, lidocaine, camphor, capsaicin (found in chili peppers), methyl salicylate, and diclofenac sodium. Popular forms include patches, creams, gels, roll-ons, and sprays.

If using an OTC topical pain reliever, make sure to always read and follow the Drug Facts label. It will tell you everything you need to know about the medicine, including the ingredients, what you are supposed to use it for, how much you should take, and when you should not take the product.

Talk to your doctor or other healthcare professional if you have questions or concerns about which OTC pain reliever to take.

I am an active athlete who competes in paddleboard competitions. I’ve learned that as older athletes push to stay on top of their game, they run a greater risk of developing all kinds of aches and pains. During one competition several years ago, I took an oral OTC pain reliever and was nearly sidelined with acute gastritis Since then, I make sure I address pain with a topical patch first. It’s my recommendation people use a topical pain reliever first before moving onto oral medication.

Disclosure: Dr. Arnot is compensated by Hisamitsu to advise on pain management issues.

Important Update: Acetaminophen

There’s been a lot of talk recently about misleading claims that taking acetaminophen during pregnancy can cause autism. We’ve pulled together some FAQs and answers to help families.
Learn more and get the facts about acetaminophen

A NOTE ABOUT DYE-FREE PRODUCTS: Dye-free medications and supplements are a great option for individuals who prefer or require products without dyes, such as those with allergies, sensitivities, or personal preferences. Importantly, both dye-containing and dye-free options are held to the same rigorous safety and quality standards. If you’re unsure which is right for you or your family, talk to your pharmacist or healthcare provider. They can help you choose the option that best suits your needs.

Safe Use Tips & Takeaways

Heart Health Takeaways

Frequently Asked Questions (FAQ)

What is fluoride?
Fluoride is a natural mineral found in water, soil, and some foods. It strengthens your enamel, repairs early signs of damage, and makes teeth more resistant to acids from bacteria and sugar.
Is fluoride toothpaste still the most effective option, or are fluoride-free formulas just as good?
Fluoride is still the gold standard for cavity protection. Fluoride-free options can clean your teeth, but they don’t offer the same enamel-strengthening power.
Is fluoride safe for daily use?
Yes. When used as directed, fluoride is safe and effective. It’s been trusted and recommended by major health organizations for over 70 years.
How does fluoride actually protect teeth?
It strengthens enamel, repairs early signs of decay, and makes teeth more resistant to acids from bacteria and sugary foods.
Are there any risks to using fluoride long-term?
The main risk—especially for young kids—is swallowing too much, which can lead to mild fluorosis. Using the right amount prevents this. For parents, supervise brushing to ensure kids spit out the toothpaste and don't swallow it. 
At what age should kids start using fluoride toothpaste?
As soon as the first tooth appears!

* Under 3 years: a tiny rice-sized smear
* Ages 3–6: a pea-size amount  

Supervise brushing so they don’t swallow it.
Is fluoride still safe and recommended for kids with all the claims online?
Yes. A lot of online claims can be confusing, but decades of research show fluoride is safe and strongly recommended for cavity prevention when used properly.
How much fluoride should my child get from toothpaste?
Use age-appropriate amounts and brush twice a day. If your water isn’t fluoridated, ask your dentist about additional options.
How do I know which kids’ toothpaste claims are real and not just marketing?
Check for the ADA Seal of Acceptance and choose brands your dentist recommends.
Do fluoride-free or “natural” toothpastes protect kids from cavities?
They can help clean teeth, but they don’t provide the same cavity protection as fluoride toothpastes.
Are fluoride-free toothpastes just as effective for adults?
Not for cavity prevention. Fluoride-free toothpastes can help with cleaning and freshening breath, but they do not protect against cavities the way fluoride does. For adults, or anyone who is prone to cavities, fluoride toothpaste remains the most effective option for preventing tooth decay.
Do fluoride alternatives like nano-hydroxyapatite (nHAp) make a difference?
Yes—nHAp can help with sensitivity and early enamel repair. But it hasn’t matched fluoride’s cavity-prevention strength in studies.
How do I compare fluoride vs. fluoride-free options if I have sensitivity or enamel wear?
Fluoride is best for strengthening enamel. nHAp may help with sensitivity. Some people benefit from using both in a balanced routine.
Are whitening toothpastes safe to use with fluoride or fluoride-free products?
Most are safe but can be abrasive. Choose gentle formulas and avoid using them every single day—especially for kids.
What should I look for when choosing an OTC toothpaste?
Pick products with proven active ingredients (like fluoride), check for the ADA Seal, and avoid unnecessary additives or sweeteners.
Does fluoride affect hormones or the brain?
No credible scientific evidence shows fluoride at levels used in toothpaste or fluoridated water disrupts hormones or causes neurodevelopmental harm.
What should I do if my community stops adding fluoride to the water?
Use fluoridated toothpaste, consider fluoride rinses, and talk to a dentist about fluoride supplements for kids.
Do fluoride supplements have side effects?
They’re safe when used under dental guidance and typically recommended for children in areas without fluoridated water.
What’s the best way to make sure I’m getting enough fluoride?
Brush twice daily with fluoride toothpaste, drink fluoridated tap water if available, and ask your dentist for personalized advice if you’re cavity-prone.

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