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Feel the Burn, FDA Warns about OTC Topical Pain Relievers

OTC Topical Pain Relievers

Feel the burn is an expression often used when talking about the lactate that builds up in your muscles during vigorous exercise. But there's another burn the Food and Drug Administration (FDA) is warning about, and it concerns the burn or blistering associated with the use of OTC topical pain relievers.

Over-the-counter pain creams rarely burn

According to the FDA, 43 cases of burns associated with the use of OTC topical creams, gels, ointments, or patches designed to relieve joint and muscle pain have been reported. There's no word on how many people may have experienced minor burns or reactions they or doctors did not report.

The products in question are those that contain the active ingredients menthol, capsaicin, and/or methyl salicylate. Other ingredients sometimes used in topical pain relievers, such as eucalyptus or oil of wintergreen, were not included in the report.

Some of the brand name products with the potentially damaging ingredients include BenGay, Capzasin, Flexall, Icy Hot, and Mentholatum.

Use of these products is supposed to produce a sensation of coolness or warmth, but in rare cases it can cause first to third degree burns or blistering after just one use, according to the FDA. Jane Filie, MD, a medical officer in FDA's Division of Nonprescription Regulation Development, noted in the FDA's report that "There's no way to predict who will have this kind of reaction to a topical pain reliever for muscles and joints."

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Creams, gels, and other topical pain relievers are helpful for treating localized pain, such as joint pain associated with arthritis. They are also an alternative for people who cannot or do not want to take pills for muscle or joint pain..

Most of the reported cases of burns and blistering involved products that contain menthol or a combination of menthol and methyl salicylate. In addition, the majority of products cited contain more than 3% menthol or 10% methyl salicylate. Few individuals were harmed by products containing capsaicin.

How to protect yourself
All of these products come with printed warnings, but here is a quick review based on information from the topical items themselves and the FDA:

  • Do not use these products on skin that is broken or irritated
  • Do not apply bandages over the treated areas. Some products say merely not to apply a tight bandage, but no bandage is safer.
  • Do not use a heating pad, hot water bottle, or heat lamp in the treated areas. Some products warn against exposing treated skin to sunlight, hot tubs, and saunas.
  • Do not allow these products to make contact with your eyes or mucous membranes (e.g., genital area or inside the nose or mouth)
  • Stop using the product if you feel pain or experience blistering and seek medical attention. Unexpected side effects should be reported to the FDA MedWatch program
  • Stop using the product and contact your doctor if your condition lasts more than 7 days
  • Do not use these products on children unless you have first consulted your physician

An added precaution could be to test the product on a very small patch of skin before you apply it to the affected joints or other areas. Wait a few hours to see if you have a negative response to the OTC topical pain reliever before using it more extensively.

FDA Consumer Updates

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