How Do Topical Drugs Reduce Back and Neck Pain?

Many different types of medication and with different methods of delivery are available to treat patients with back and neck pain. Drugs that help to control pain include narcotics, anti-inflammatories, muscle relaxants, antidepressants, anti-anxiety medications, and topical anesthetics. Your physician may combine one or more types of medication for maximum relief or to limit the side effects of larger doses of a single agent.

Medication classes with lower potency or risk of side effects are available over-the-counter. Stronger dose formulas and controlled drugs are available only with a physician's prescription. Patients must remember that just because a medication is obtainable without a physician's prescription does not mean it is entirely safe! Please read the label and follow dosing guidelines to the letter.

Lidocaine tube and boxExample of a topical pain medication. Photo Source: in higher doses, even acetaminophen (Tylenol) can cause severe liver damage. It may be helpful to discuss these medications with the pharmacist before trying one. If you are going to continue to take the over-the-counter drug, tell your physician about it. To decrease the risk of side effects or potentially severe drug interactions, tell your physician about all the products you take, including herbal remedies.

For acute pain, intramuscular and intravenous injections are used. For chronic pain, medications are typically delivered orally in pill form. Both of these methods have their limitations and alternate routes of medication delivery may be considered. These include inhalation or rectal or topical application (to the skin).

Nonpatch Type Topical Pain Relievers

Topical pain relieving drugs include preparations applied to the skin as a cream, ointment, gel, spray, or patch (eg, Lidoderm patch). This article discusses the use of non-patch type topical pain relievers. Topical drugs seek to reduce inflammation below the skin surface and soothe nerve pain. Some of these drugs are available only with a physician's prescription and others can be bought over-the-counter.

In 1980, the first 'through the skin' (TTS) therapeutic, or transdermal product, was introduced. Since then scientists around the world continue to develop safer and more expedient methods to deliver drugs, hormones, and supplements into the human body. Administering medication and health enhancing formulations through the skin is becoming more popular.

Unlocking Skin Cells

Skin is the largest organ of the human body. It serves as a protective water barrier, regulates temperature, controls fluid loss, and performs many other functions important to homeostasis (healthy internal balance). Skin is comprised of many layers supported by an intricate blood supply. The blood vessels pass below the skin in a framework of connective tissue including fat and fascia (the "gristle" that holds the tissues together. Below that layer lays the bone and muscle. The skin also contains nerve endings which carry touch, temperature, and pain signals from the skin to the spinal cord and on to the brain.

Anatomy of human skin, layersScientists have developed compounds to safely carry medications and other compounds through the skin layers into the blood. Photo Source: have developed compounds to safely carry medications and other compounds through the skin layers into the blood. It is thought that certain compounds help to penetrate the skin barrier by opening naturally closed channels for a period of time. These penetration enhancers help the skin to absorb the drug.

Topical Pain Medications and Spine Pain

Spine care physicians and pain specialists may recommend a topical pain-reliever to help relieve the symptoms of various back and neck disorders. For example, a topical medicine may be used to treat the pain associated with osteoarthritis, rheumatoid arthritis, neck or low back strain, whiplash, muscle inflammation and spasms, and some types of nerve pain.


  • Base (cream, ointment, gel, spray) makes application easy and controllable. 
  • Onset of symptom relief is usually faster than oral preparations.
  • Symptoms are relieved at a steady rate and relief may last longer. 
  • A smaller amount of medicine may be needed when applied in a topical form. 
  • Formulations diffuse through the skin and enter the bloodstream, initially bypassing the digestive system (called 'first pass'). Many systemic (whole body) side effects, such as irritated stomach lining, may be lessened or eliminated. 


  • The blood flows differently to different parts of the body. Therefore, patient education about product use is essential. For example, the patient needs to know where to apply the product (such as the arm or abdomen) and how often.
  • Along the same lines, blood flow to a given part of the body can change over time. In colder weather, the blood vessels going to the skin contract decreasing the absorption of the medication. Exercise and sweating may open pores too much and increase medication inflow or wash it away altogether.
  • Since topical products are used differently than those taken orally or by injection, some patients may need to pay more attention to proper use.
  • Skin reactions are possible. Patients need to know what to do if an allergic or other reaction develops.
  • Skin nerves are different from spinal nerves. Therefore, certain types of back and neck pain will not respond to topical treatment.
  • Spinal disorders originating deep in the body do not respond well to topical therapy.

Is it right for you?

Is a topical pain relieving medication the right treatment for you? The best person to ask is your physician. Depending on the diagnosis and your medical history, your physician has various treatments for managing spine pain.

Author's Closing Comments

Patches and creams can be used to deliver a wide variety of different medications from birth control to pain medications. These transdermal agents are increasingly popular because of their convenience and, in some cases, improved side effect profile.

For example, for patients with chronic, severe pain, a fentanyl patch may applied once every three days rather than taking a pill every six hours. For patients with localized muscle or tendon inflammation, application of a cream to the affected area limits the amount of the medication that goes to parts of the body that do not need it. For patients with stomach problems that have a hard time taking anti-inflammatories by mouth, these creams may all them to keep physically active.

Patients with chronic neck or back pain should discuss transdermal medications with their pain management or spine-care physician to see if one of these agents may be right for them.

Updated on: 08/29/19
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