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Using painkillers is an essential way to get relief when you strain a muscle (like a hamstring) or sprain a ligament (like the ones that stabilize the ankles). Topical painkillers — such as ointments, creams, sprays, and patches that are applied to the skin — are a good choice.

“In general, if a topical formulation works for someone, my preference and recommendation is to go with that, because the effects stay much more localized, targeting just the relevant part of the body,” says Dr. Sarah Eby, a physiatrist with Mass General Brigham Sports Medicine. “As a result, other parts of the body are exposed to lower levels of the medicine.”

Fewer risks

Lowering medicine levels in the blood is an important consideration, since some painkillers pose severe risks. For example, long-term use of oral nonsteroidal anti-inflammatory drugs (NSAIDs) in pill form, such as ibuprofen (Advil, Motrin), leads to blood levels that can increase blood pressure, irritate the stomach lining and cause ulcers or stomach bleeding, and damage the kidneys. Even short-term use of NSAID pills raises heart attack and stroke risk.

If you use a topical NSAID, however, the drug reaches primarily the part of the body that’s in pain: blood levels are much lower than they are when people take NSAID pills. “For example, a 2013 trial that analyzed the amount of NSAIDs in the body following oral versus topical treatment applied to one area — the knee — found that oral use led to 17 times the level, compared to topical use,” Dr. Eby says. Topical NSAIDs might also reduce the risk of gastrointestinal side effects, since the medication is absorbed into the bloodstream through the skin, skipping most of the digestive tract.

Top topicals

Many types of topical painkillers are available. We asked Dr. Eby to rank them, starting with the ones she’d be most likely to mention to patients.

NSAIDs. Topical diclofenac gel (Voltaren) or topicals with salicylates, the active ingredient in aspirin (Aspercreme, Icy Hot, Bengay), help reduce pain and inflammation.

Lidocaine. Lidocaine, available in patches, is an anesthetic that eases pain by numbing nerves and some tissues.

Menthol or camphor. These substances make your skin feel hot or cold. When applied to an area of the body in pain, the hot or cold distracts the brain from focusing on the pain signals.

Capsaicin. This is a chili pepper extract. “It reduces certain molecules that send pain messages to the brain,” Dr. Eby says. “But capsaicin can be quite hot and painful when you first begin using it — wear gloves when applying it. Its effects wear off if it isn’t used regularly.”

Herbal remedies. Arnica gel is thought to have anti-inflammatory properties. “I have a lot of patients who like it. It’s not regulated by the FDA, and we don’t have much data about how well it works. But if you have a product that isn’t too expensive and it’s from a company you trust, it might be reasonable to try it,” Dr. Eby says.

Other considerations

Topical painkillers are available over the counter and are generally safe for most people. “Follow the directions on the packaging to avoid side effects, such as skin irritation — especially with lidocaine patches, which are typically worn for 12 hours on and then 12 hours off,” Dr. Eby says. (It’s okay to use another type of topical when you’re not wearing a patch.)

If you need to use topical medications for more than a few days (for new pain) or for long stretches of time (for familiar pain), or if topicals don’t work well for you, call your doctor. “What you thought was perhaps a minor sprain or strain could be something more serious,” Dr. Eby says.

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