Menthol comes from peppermint oil extracted from plants. It can be both naturally extracted from plants and produced from chemicals. Menthol creates a pleasant diversion with its cooling sensation from pain and other irritations. It can therefore only provide relief for minor pain, and is not really a treatment for pain or inflammation.
One small study compared the ability to complete functional tasks and knee pain while completing functional tasks among patients with knee osteoarthritis (OA) after topical application of either 3.5% menthol gel or an inert placebo gel. Participants who used the menthol gel had significantly reduced pain during exercises and while climbing stairs compared with those who used the placebo gel. However, there were no differences detected in functional tasks or pain following the placebo and menthol conditions.
What Is a Counterirritant?
Counterirritants are used to produce surface irritation of the skin to counteract underlying pain or discomfort. Examples of counterirritants include menthol, camphor, capsaicin, and methyl salicylate.
Topical Menthol Treatments
Topical menthol treatments contain menthol and sometimes other active ingredients as well:
- Absorbine Jr. contains menthol.
- Activene Arnica Gel Cream contains menthol and other ingredients.
- Bengay sometimes contains menthol as active ingredient, but also contains camphor and methyl salicylate in other types.
- BioFreeze contains menthol.
- Dr. Bronner’s Arnica-Menthol Organic Magic Balm contains a blend of arnica, camphor, menthol and peppermint oils.
- Flexall contains menthol, camphor, and methyl salicylate.
- Icy Hot contains menthol and sometimes methyl salicylate depending on the strength of the product.
- Mentholatum contains menthol and camphor.
- Mineral Ice Menthol Pain Relieving Gel contains menthol.
- Sombra Warm Therapy natural pain relieving gel contains menthol and camphor.
- Stopain topical pain reliever contains menthol.
- Tiger Balm contains a combination of menthol and camphor.
- Vicks VapoRub contains menthol, camphor, and eucalyptus oil.
Menthol can cause eye and skin irritation. A high-percentage menthol product can cause irritation and even chemical burns. There are a few reports of people having severe skin reactions to even small amounts of menthol.
It is possible for menthol products to cause organ failure if it's swallowed or inhaled in concentrated amounts. Serious effects include seizures, coma, and death. Also, menthol pain relievers should be kept out of reach of children and not applied to a child under 12 years old.
Here are some important rules to follow when using menthol lotions:
Don't apply menthol products to damaged or irritated skin.
Don't put bandages on the area where you've applied the lotion.
- Don't apply heat to the area using heating pads, hot water bottles, or lamps. Doing so increases the risk of serious burns.
- Don't allow these products to come in contact with eyes and mucous membranes (such as the skin inside your nose, mouth, or genitals).
It is normal for these products to produce a warming or cooling sensation where you've applied them. But if you feel actual pain after applying them, look for signs of blistering or a burn. Most topical pain relievers should not be used for more than seven days because it could result in a rash or chemical burn on your skin. If you see any of these signs, stop using the product and seek medical attention.
If you experience pain, swelling, or blistering of the skin where an over-the-counter (OTC) menthol lotion was applied, stop using the product and seek medical attention immediately. These products should produce a warm or cool sensation, not pain or skin damage.
How To Use Topical Menthol Treatments
When using any menthol lotions, apply it to a small skin area first to see how your skin reacts to it. If you experience a burning sensation, wash the skin with soap and water and then call your doctor.
A menthol patch typically works well on an area where it can be applied to a flat surface, so it might be best to get a menthol patch if you have back or neck pain. If you have pain in an area that moves a lot or is in a joint that bends, a cream or gel may be best so that you can still move that joint.5
For menthol creams or gels:
- Wash hands with soap and water
- Clean the skin of all other lotions, creams, or ointments
- Dry your hands
- Apply a thin layer to the affected area
- Rub it gently into painful area until thoroughly absorbed into skin
- Do not reapply more than three or four times per day, allowing a minimum of two to three hours between applications
- After applying, wash hands with soap and water again
For a menthol roll-on:
- Rub a thin film over the affected areas, not more than four times daily
- Do not massage the liquid into your skin
For menthol patches:
- Peel off the protective backing and apply sticky side to affected area
- Carefully remove backing from patch
- Should be used up to eight hours
- Should be used no more than three times a day
- Consult your doctor if you want to use them on children under 12 years old
The side effects that can occur with menthol product use include:
- Skin redness
- Skin irritation
- Eye irritation
- Chemical burns (with higher-percentage menthol products)
In severe cases:
- Rapid breathing
- Shallow breathing
- Eye irritation
- Vision loss
- Ringing in the ears
- Thirst
- Throat swelling
- Agitation
- Dizziness
- Drowsiness
- Fever
- Hallucinations
- Loss of appetite
- Nausea and vomiting
While it is convenient and generally safe to use OTC topical pain relievers, it is possible to have a severe reaction or apply too much of these products. Menthol lotions and gels are no different. If your pain lasts more than seven days, treating the area with a pain-relieving topical product may just be masking a more serious problem. See your doctor if your pain keeps coming back, or if the topical cream, gel, lotion, or patch is causing skin irritations, burns, or making you feel sick.
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