Doctor’s top picks for short-term pain relief

Pain comes from many different sources — arthritis, headaches, low back pain, inflammation, menstrual cramps, fever and flu, nerve, cancer, and more. If you must use a medication, I recommend you do all you can with safer medications before resorting to narcotic or other problematic pain relievers.

But, in the short term — and for short-term types of pain — most people reach for some sort of medicinal pain reliever.

Let me give you my step-wise approach if you’re considering medications for pain control, beginning with over the counter and topical formulations.

Non-prescription pain relief

Effective non-prescription pain relievers include:

  • Acetaminophen: (e.g. Tylenol®), is harmless at usual doses, but can affect your liver at high sustained dosing over weeks. 1
  • Motrin and Aleve: NSAIDs (non-steroidal anti-inflammatory drug) help mild to moderate pain. I encourage these for the first 3-5 days after an injury to slow inflammation, and to discontinue them as soon as possible to encourage healing. Also be aware that you increase your risk for increased stomach acid and even death from stomach bleeding: It was reported in 1999 that NSAIDs were the 15th leading cause of deaths in the U.S, directly causing more than 16,000 deaths and 100,000 hospitalizations annually. 2 NSAIDs can be problematic for people with heart conditions.
  • Arnica (Arnica montana): an herbal pain reliever cream, ointment, salve, or tincture used to soothe muscle aches, reduce inflammation, and even help heal skin wounds. Its use for medicinal purposes goes back to the 1500s.
  • White willow bark (Salix alba): contains salicin (similar to acetylsalicylic acid of Aspirin) and also polyphenols and flavonoids that have antioxidant, fever-reducing, antiseptic, and immune-boosting effects. 3
  • Turmeric (Curcuma longa): at high doses is safe and quite effective to relieve various sources of pain: joint, head, and more. It has been studied and found to be as effective as Ibuprofen for arthritis pain, yet safer on the stomach. 4 One patient of mine used 2400 mg daily with great headache pain relief. It can be taken in capsules or in food, like golden milk. Read another doctor’s impressive case history about turmeric found online here.

Safe, effective topical prescriptions

For stronger pain relief there are also prescription topical pain relievers. These are quite safe because it is estimated that only 2-3% of the medicine actually gets into your blood stream.

A pharmacist must be specially trained in compounding these in their lab, so they are not found at your typical pharmacy chain stores (CVS, Rite-aid, Walgreens, etc.). They are mixed into a lipoderm base and applied to an area where you experience pain, and absorbed through the skin.

Compounded topical pain relief ingredients consist of one or more of the following:

  • Ketoprofen, Diclofenac, or Ibuprofen: in creams these give good pain relief and anti-inflammatory effect for sprains, strains and overuse injuries—similar to oral NSAIDs. 5
  • Lidocaine: a well-known topical anesthetic. At 5%-10% it can be quite effective even to deeper tissues.
  • Ketamine: when applied on your skin absorbs into your blood circulation and reduces pain by central nervous system sensitization and also through peripheral nerve action at opioid and sodium-potassium channels. 6 In one small study, pain rated on a 1-10 scale was on average 8.8 before application of ketamine gel and fell to 1.6 at fifteen minutes after application of the gel; all subjects reported significant pain relief. 7
  • Gabapentin: a nerve modulator that blunts pain, also known as Neurontin.
  • Clonidine: In a placebo-controlled trial of 179 subjects using 0.1% topical clonidine gel applied 3 times a day to their feet for 12 weeks it significantly reduced foot pain in painful diabetic neuropathy subjects. 8
  • Capsaicin: at 8% this topical cream has been closely compared to Lyrica for neuropathy pains. 9 In a March 2016 report, the 8% capsaicin patch and the 5% topical lidocaine patch were reported to be significantly more effective than oral gabapentin, opioid narcotics, Lyrica® and tricyclic anti-depressants (e.g. Amitriptyline) for post-herpetic neuralgia. 10
  • Tramadol: Studies show this to be equally effective as ketamine in for post-surgical mouth/throat pain. 11 2
  • Amitriptyline: tricyclic antidepressant. In a small 21-subject study using 2% topical amitriptyline plus 1% ketamine cream showed this was safe and effective for neuropathy. At the end of 12 months 89% of subjects rated their satisfaction in pain reduction as 3 out of 5 or greater and two of the subjects were pain free; there were no serious adverse events.

Really severe pain is almost always very short-lasting. And there is a psychology that universally develops with chronic pain. In my next article I would like to discuss my discoveries regarding severe or prolonged pain relief management and the new opioid guidelines from the CDC (Centers for Disease Control).

To feeling good in health!
Michael Cutler, M.D.

[1] Ann Intern Med. 1977;87(3):299-301 found online at:  http://annals.org/article.aspx?articleid=691409
[2] Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. N Engl J Med. 1999 Jun 17;340(24):1888-99.
[3] Shara M, Stohs SJ. Efficacy and Safety of White Willow Bark (Salix alba) Extracts. Phytother Res. 2015 Aug;29(8):1112-6.
[4] Kuptniratsaikul V, Dajpratham P, Taechaarpornkul W, et al. Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee osteoarthritis: a multicenter study. Clin Interv Aging. 2014 Mar 20;9:451-8
[5] Derry S, Moore RA, Gaskell H, Wiffen PJ. Topical NSAIDs for acute musculoskeletal pain in adults. Cochrane Database Syst Rev. 2015 Jun 11;6:CD007402.
[6] Poyhia R, Vainia A. Topically administered ketamine reduces capsaicin-evoked mechanical hyperalgesia. Clin J Pain. 2006 Jan;22(1):32-6.
[7] Gammaitoni A, Gallagher RM, Welz-Bosna M. Topical ketamine gel: possible role in treating neuropathic pain. Pain Med. 2000 Mar;1(1):97-100.
[8] Campbell CM1, Kipnes MS, Stouch BC, Brady KL, Kelly M, Schmidt WK, Petersen KL, Rowbotham MC,Campbell JN. Randomized control trial of topical clonidine for treatment of painful diabetic neuropathy. Pain. 2012 Sep;153(9):1815-23.
[9] Mankowski C1, Patel S2, Trueman D3, Bentley A3, Poole C1. Cost-Effectiveness of Capsaicin 8% Patch Compared with Pregabalin for the Treatment of Patients with Peripheral Neuropathic Pain in Scotland. PLoS One. 2016 Mar 16;11(3):e0150973.
[10] Armstrong EP1, Malone DC, McCarberg B, Panarites CJ, Pham SV. Cost-effectiveness analysis of a new 8% capsaicin patch compared to existing therapies for postherpetic neuralgia. Curr Med Res Opin. 2011 May;27(5):939-50.
[11] Gönül O1, Satilmiş T2, Ciftci A3, Sipahi A3, Garip H2, Göker K4. Comparison of the Effects of Topical Ketamine and Tramadol on Postoperative Pain After Mandibular Molar Extraction. J Oral Maxillofac Surg. 2015 Nov;73(11):2103-7.
[12] Tekelioglu UY1, Apuhan T, Akkaya A, Demirhan A, Yildiz I, Simsek T, Gok U, Kocoglu H. Comparison of topical tramadol and ketamine in pain treatment after tonsillectomy. Paediatr Anaesth. 2013 Jun;23(6):496-501.

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Dr. Michael Cutler

By Dr. Michael Cutler

Dr. Michael Cutler is a graduate of Tulane University School of Medicine and is a board-certified family physician with more than 20 years of experience. He serves as a medical liaison to alternative and traditional practicing physicians. His practice focuses on an integrative solution to health problems. Dr. Cutler is a sought-after speaker and lecturer on experiencing optimum health through natural medicines and founder of the original Easy Health Options™ newsletter — an advisory on natural healing therapies and nutrients. His current practice is San Diego Integrative Medicine, near San Diego, California.