Pain Patch Types, Benefits, and Warnings

A pain patch is a medication-containing patch that is applied to the skin to manage acute (short-term) and chronic (long-term) pain. Some are available over the counter (OTC) and some require a prescription.

Depending on the type of pain patch you use, there can be concerns about side effects like allergic reactions, stroke, or the possibility of developing a drug dependence.

This article discusses pain patches, how they work, and what they are used to treat. It also explains how to use a pain patch, doses, and side effects.

Benefits

Pain patches are used to treat various types of pain. The patch has an adhesive back that sticks to the skin. It slowly releases the medication into the bloodstream. Some types are available over the counter (OTC) while others are only available by prescription.

Your healthcare provider may recommend a pain patch if you have pain that doesn't respond well to oral medications or if you are unable to take drugs orally because of stomach irritation or other conditions.

Non-prescription pain patches may help treat minor pain such as:

• Joint pain/arthritis
• Minor muscle strains

Prescription pain patches may be used for moderate to severe pain such as:

• Neuropathy
• Severe sprains and strains
• Moderate to severe arthritis pain
• Chronic pain such as cancer pain

Types of Pain Patches

The type of pain patch you should use depends on the type of pain you have and its severity. Your healthcare provider can recommend an OTC pain patch or prescribe something stronger if it's needed.

Capsaicin

Non-prescription capsaicin patches are sold under a few different brand names, including Aspercreme Warming and Salonpas Pain Relieving Hot. Your healthcare provider may recommend an OTC capsaicin patch for mild arthritis pain, minor muscle sprains, minor back pain, etc.

Capsaicin patches are also available in prescription strength. These may be recommended to treat nerve pain such as the pain from diabetic neuropathy.

Capsaicin patches contain a substance naturally found in chili peppers, which works by decreasing the activity of nerve cells that cause pain.

Lidocaine

Lidocaine, also known by the brand name Lidoderm, is available OTC or with a prescription. OTC lidocaine patches are sold under the brand names Absorbine Jr, Aspercreme, Lidocare, and others. OTC lidocaine patches are used for minor pain in the legs, arms, shoulders, and neck.

Prescription lidocaine patches are often used for patients suffering from the pain of shingles (postherpetic neuralgia), which can last for months or years after an infection.

Lidocaine is a local anesthetic that works by stopping nerves from sending pain signals. The topical lidocaine 5% patch is generally well-tolerated, other than mild skin reactions at the application site. It is fast-acting; some people start to feel relief in as little as 30 minutes.

Diclofenac Epolamine

Diclofenac epolamine is a prescription pain patch containing a non-steroidal anti-inflammatory medication (NSAID). It is in the same group of medicines as aspirin and ibuprofen. Also known by the brand name Flector, it can be applied near the area of pain if there’s no broken or damaged skin.

Studies have found that diclofenac patches are as effective as oral diclofenac in controlling pain.

Fentanyl

Healthcare providers may prescribe fentanyl patches for severe, chronic pain.

Fentanyl patches are also known by the brand name Duragesic. They should be used only by patients who can tolerate opioids and those with long-term, severe pain who can’t be treated with other medications.

A 2018 study found that fentanyl patches were as effective as oral morphine in managing moderate to severe cancer pain with fewer side effects, such as nausea and vomiting.

Precautions and Contraindications

Before using a prescription pain-relief patch, talk with your healthcare provider about any allergies you have and if you’re taking any other medications or supplements. Also, tell your healthcare provider if you’re pregnant, plan to become pregnant, or are breastfeeding. 

Some drugs may be safer for you to use than others depending on your medical history and the cause of your pain. Your healthcare provider can help you weigh the pros and cons of a medication, including its ability to manage pain and the risk of side effects.

Because fentanyl is a strong opioid, it can be addictive. As such, tell your healthcare provider if you or anyone in your family has abused alcohol, street drugs, or prescription medications, or if you have ever had depression or another mental illness.

Fentanyl patches should only be used by patients who have previously taken and tolerated opioid medications.

Tell your healthcare provider if you have asthma or any condition with slowed breathing, as you may be advised not to use fentanyl patches. Also tell your healthcare provider if you’ve ever had lung disease, a head injury, or any condition that increases pressure in your brain.

Common Side Effects

Pain patches may have side effects depending on the type used. Check with your healthcare provider or pharmacist about what symptoms should warrant discontinuing the medication or seeking medical attention. If you are using a fentanyl patch, your healthcare provider will closely monitor you during treatment to check for any serious side effects. 

In some cases, a patch can cause minor irritation, redness, blisters, nausea, or a burning sensation where it is applied. These symptoms are usually minor and go away within a few hours. Check with your healthcare provider if symptoms are severe or don’t go away.

Severe Side Effects

Severe side effects are associated with the different types of patches.

Capsaicin Patches

Capsaicin patches may cause severe side effects such as:

• Cough and/or throat irritation
• Eye irritation or eye pain
• Swelling or pain where the patch was applied
  

Lidocaine Patches

Side effects from the lidocaine patch may include allergic reactions, such as:

• Hives
• Skin rash
• Itching
• Difficulty breathing
• Difficulty swallowing
• Swelling
• Hoarseness
• Fast pulse
• Fast breathing
• Unusual thirst
• Nausea
• Vomiting
• Confusion
• Weakness
• Dizziness
• Fainting

Symptoms of an overdose can include:

• Lightheadedness
• Nervousness
• Blurred vision
• Ringing in the ears
• Twitching or shaking
• Seizures
• Slow heartbeat
• Loss of consciousness

NSAID Patches

NSAIDs can increase the risk of heart attack, stroke, and bleeding in the stomach or elsewhere in the gastrointestinal tract. Seek medical attention if you have:

• Shortness of breath
• Slurred speech
• Nausea
• Weakness
• Diarrhea
• Yellow skin or eyes
• Indigestion
• Stomach pain
• Vomiting blood
• Blood in your bowel movements
• Swelling
  

Fentanyl Patches

The fentanyl patch can cause severe side effects such as:

• Changes in heartbeat
• Agitation
• Hallucinations
• Fever
• Sweating
• Confusion
• Severe muscle stiffness or twitching
• Seizures
• Hives
• Swelling
• Hoarseness
• Difficulty breathing or swallowing

While you are using fentanyl patches, you may be told to have a rescue medication called naloxone available in case of overdose. Symptoms of an overdose include:

• Difficulty breathing
• Extreme sleepiness
• Difficulty talking
• Trouble with walking
• Small eye pupils
• Faintness
• Dizziness
• Confusion
• Coma (prolonged loss of consciousness)

Warnings and Contraindications

Be sure your healthcare provider is aware of any other medical conditions you have, including liver or kidney problems and high blood pressure, and any medications and supplements you’re taking. 

Capsaicin Patch

Do not use capsaicin patches if you're allergic to chili peppers or you've had an allergic reaction to topical capsaicin. 

Capsaicin is unlikely to interact with other drugs, but always let your healthcare provider know about any OTC or prescription medications you take as well as any supplements you may be using.

Lidocaine Patch

Tell your healthcare provider if you are using any medications, including:

• Norpac (disopyramide)
• Tambocor (flecainide)
• Medications applied to the skin or mouth to treat pain
• Mexitil (mexiletine)
• Ethmozine (moricizine)
• Procanabid
• Pronestyl (procainamide)
• Rhythmol (propafenone)
• Quinidex (quinidine)
• Tonocard (tocainide)
  

Diclofenac Epolamine Patch

The diclofenac epolamine patch can interfere with the effects of other medications or cause drug interactions. Let your healthcare provider know if you’re using:

• Anticoagulants
• Aspirin
• ACE inhibitors
• Angiotensin receptor blockers (ARB)
• Beta-blockers
• Diuretics
• Digoxin
  

Fentanyl Patch

When using a fentanyl patch, do not drink alcohol or take street drugs, as it can increase the risk of severe side effects or death. Tell your healthcare provider about any other medications you’re using to avoid life-threatening interactions.

Drugs that can cause a serious interaction include benzodiazepines such as:

• Xanax (alprazolam)
• Klonopin (clonazepam)
• Valium (diazepam)
• Ativan (lorazepam)
• Medications for mental illness, depression, and nausea
• Other medications for pain
• Muscle relaxants
• Sedatives
• Sleeping pills
• Tranquilizers

Not all drug interactions are listed here. Always let your healthcare provider know about any medicines or supplements you're taking before you start using a fentanyl patch.

Fentanyl patches can be dangerous in the wrong hands or if applied improperly. The U.S. Food and Drug Administration (FDA) has issued warnings about fentanyl patch safety after a number of accidental overdoses were reported.

Overdoses have occurred when more than one patch is used at a time, when a patient applies heat to the patch, and when a non-patient—such as a child—accidentally comes into contact with a patch. According to the FDA, young children have died from accidental exposure when putting it in their mouth or applying it to their skin.

In 2013, the FDA required color changes on the writing of Duragesic (fentanyl) patches. The change was made so patients could more easily see the patches and notice when they fall off to avoid accidental exposure to kids and pets.

How to Use Pain Patches

The adhesive side of the transdermal patch should be placed firmly on the skin per the label and healthcare provider instructions. Never place a patch in an area for which it is not prescribed, and never use more than one patch at a time unless approved by your healthcare provider.

All listed dosages are according to the drug manufacturers. Check your prescription and talk to your healthcare provider to make sure you’re taking the right dose for you. Some common doses are as follows:

• Non-prescription .025% capsaicin patch: This is applied to the skin three or four times a day and for no more than eight hours at a time.
• Qutenza 8% capsaicin patch: For diabetic neuropathy, up to four patches may be applied for 30 minutes once every three months.
• Nonprescription 4% lidocaine patch: Apply to the skin for no more than eight hours up to three times a day.
• Lidoderm patch with 5% lidocaine: Apply once a day to the largest area of skin that has pain for up to 12 hours. Check with your healthcare provider on the number of patches that can be used at once.
• Flector patch with 1.3% diclofenac epolamine: The manufacturer’s recommended dose is one patch applied to the most painful area twice a day.
  
• The fentanyl patch: Apply to the skin once every 72 hours. Your healthcare provider may start you on a low dose of fentanyl and gradually increase it if needed. Fentanyl patches do not need to be placed on top of the area of pain. Apply to clean and dry skin. Choose a flat area, such as the upper arm, chest, or back.

Pain-relief patches should only be used on skin that is not broken, cut, or scraped. Do not use a pain-relief patch that has been cut, torn, or damaged unless directed to do so by your healthcare provider.

Store all pain patches at room temperature and away from excess heat. Like all medicines, pain-relief patches should also be stored away from children and pets.

Fentanyl patches are dangerous even after being used because they still contain high amounts of opioids. The best way to dispose of a used fentanyl patch is to fold it in half, so the adhesive side sticks to itself. A used patch should be flushed down the toilet.

Summary

Pain patches are patches that contain pain reliving medication and are applied to the skin. They are available over the counter or as prescribed by your healthcare provider. Pain patches are usually recommended if you can't take oral medication because of side effects or if you have pain that does not respond to oral medication.

Capsaicin and lidocaine patches are available without a prescription. Stronger versions containing these medications are also available. Other prescription products contain NSAIDs or fentanyl. These drugs may interact with other medications or cause severe side effects. Always tell your healthcare provider about other medications you may be taking before using a pain patch.