Menthol (also known as “mint camphor”) is a volatile oil extract derived from the genus Mentha which is available in natural and synthetic forms. Since ancient times, menthol has been used as a non-opioid pain reliever. It is prepared from the extracts of peppermint oil and provides a cooling sensation when applied to the skin externally. This helps to relieve pain in the tissues underneath the skin and is often used to provide temporary relief in muscles or joint pain, minor arthritis pain, backache, or painful bruises.
Known as a counter-irritant, menthol works by causing the skin to feel cool followed by a warm sensation. These sensations actually enable to distract the person from feeling the pain in the muscles and joints. This cooling feeling desensitizes nerve endings just like ice or cold packs and curbs arterial blood flow to the inflamed region. [1, 2]
- Menthol is used to relieve coughs, soothe oral discomfort or injury of the mouth and gums as well as useful for sore throat, fever blisters and cold sores.
- It helps to control plaque or kill bacteria that can contribute to the development of gingivitis; relieve minor pains of muscles and joints, relieve irritated lips and skin, depending on the dosage and form.
- Menthol can be the sole ingredient in topical cough suppressant medicines (such as lozenges or sprays) or be combined with other ingredients in multi-symptom cough and cold medicines, anti-gingivitis and anti-plaque products. 
A vasoactive compound, menthol is a selective activator of transient receptor potential melastatin-8 (TRPM8) channels. It acts as a counterirritant (topical agent) by imparting a cooling effect and stimulating nociceptors and desensitizing them. Topically applied menthol might also activate central analgesic pathways. At higher concentrations, menthol may generate cold allodynia.
Menthol is effective as a topical analgesic through an interaction with the network of embedded nerves in the skin’s dermal-epidermal junction. On application of the cream, the nerve endings detect cutaneous stimulation which activate inflammatory responses, which then causes the release of vasoactive neuropeptides ultimately sending pain signals. The nerves can be broadly categorized as unmyelinated C-afferent fibers (which conduct slowly) and myelinated A-afferent (conduct more quickly, and have no myelin sheath). A-afferent are thus extremely sensitive to thermal, chemical and physical stimuli, and upon external stimulation, these unmyelinated termini send neural impulses that allow precisely timed opening of the voltage-gated ion channels such that sodium, potassium, chloride and calcium ions are freely allowed the inflow and outflow through the membrane of the neuron. [3,4]
- On application, redness, warmth or irritation may occur.
- In case of blistering/swelling at the application site or unusual pain, inform your doctor immediately.
- A very serious allergic reaction to this drug is rare. Symptoms include rash, breathing difficulties, itching, swelling (especially of the face/tongue/throat) and severe dizziness. 
- Talk to your doctor or pharmacist if you are allergic to menthol or suffer from any other allergies in general.
- Discuss your medical history before application.
- If you are going for surgery, discuss with your doctor or dentist about all the products and medicines you use.
- During pregnancy and breast feeding, this medication should be used only under the guidance of a reputed physician. 
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Shubham Pharmachem’s blog & articles have been written with the information gathered from approved medical journals and websites online. Our research and the technical team strives to provide relevant information through such articles. We strongly advise readers to not consume or administer any medication without prior consultation with their doctor.
 Cleveland Clinic [online]: https://health.clevelandclinic.org/topical-pain-relief-what-is-it-and-how-does-it-work/
 Know your OTCs [online]: https://www.knowyourotcs.org/ingredient/menthol/
 Wiley Journal [online]: https://onlinelibrary.wiley.com/doi/full/10.1111/jcpt.12679
 WebMD [online]: https://www.webmd.com/drugs/2/drug-173171/pain-relief-menthol-topical/details