Published: December 2012


The Burning Issue with Pain Relief Creams

This article is more than five years old. Some content may no longer be current.

Prescriber Update 33(4): 32-33
December 2012

The Food and Drug Administration (FDA) has recently advised of serious application site injuries being reported following the use of over-the-counter (OTC) topical muscle and joint pain relievers1. Injuries included first- to third- degree chemical burns, with some requiring hospitalisation. In many cases, burns occurred after only one application, with severe burning or blistering occurring within 24 hours.

OTC topical muscle and joint pain relievers are available as single or combination-ingredient products. In the majority of the FDA reports, severe burns occurred with the use of menthol or menthol/methyl salicylate combination products with the concentration of menthol greater that 3% and methyl salicylate greater than 10%. However, a few of the cases involved capsaicin-containing products.

In New Zealand, the Centre for Adverse Reactions Monitoring (CARM) has received four reports of burns following the use of OTC topical muscle and joint pain relievers. Of the four reports, one patient required hospitalisation following the use of a methyl salicylate-containing product. The remaining reports involved the use of capsaicin-containing products.

OTC topical muscle and joint pain relievers following application should cause a local sensation of warmth or coolness. However, if any pain, swelling or blistering of the skin develops, patients should be advised to stop using the product and to wash the affected area to remove any remaining product. If symptoms persist, patients should be advised to see a healthcare professional.

In order to reduce the risk of adverse effects, patients should be advised to:

  • use a small amount of product for each application and to gently rub in to the affected area
  • wash residue from hands after use (or 30 minutes after application if treating hands)
  • avoid applying these products to broken or irritated skin
  • avoid contact with eyes and mucous membranes
  • avoid applying bandages or heat (heating pads, hot water bottles, heat lamps) to the area where the product has been used
  • avoid hot showers or baths immediately before or after application.

OTC topical muscle and joint pain relievers available in New Zealand include Zostrix (capsaicin), Deep Heat (menthol/methyl salicylate), Metsal (menthol/methyl salicylate), Ice Gel (menthol), and Tiger Balm (multiple actives).

Healthcare professionals are reminded of the importance of counselling patients about how to use the products appropriately when recommending topical muscle and joint pain relievers to patients. Any serious suspected adverse effects should be reported to CARM.

  1. Food and Drug Administration. 2012. Rare cases of serious burns with the use of over-the-counter topical muscle and joint pain relievers. FDA Drug Safety Communication 13 September 2012. URL: (accessed 8 November 2012).
Hide menus
Show menus
0 1 2 4 5 6 7 9 [ /