Poster Number-36 - Bibliometric Analysis of Camphor and Menthol Containing Topical Anesthetics

Bibliometric Analysis of Camphor and Menthol Containing Topical Anesthetics

Purpose:

In the United States, there are more than 25 millions adults living with chronic pain.¹ With opioids responsible for significant healthcare, social, and economic burdens, there is an urgent need for alternative pain management treatments.² However, currently, options are limited for non-opioid options that are both safe and efficacious in relieving pain.² One alternative pain management includes topical analgesics, which tend to be safer, have lower risk of addiction, and are more accessible than oral and parenteral therapies.^3,4 Examples of topicals commonly seen in literature include compounds containing capsaicin, lidocaine, topical antidepressants, ketamine, clonidine, gabapentin, baclofen, phenytoin, and/or NSAIDs.⁴ It is evident that more studies are needed for elucidation of the role of topical analgesics and their effects, especially when combined with other treatments.⁴

Given the demonstrated efficacy of topical agents in relieving pain, the authors were interested in looking for other possible topical agents. One agent, in particular, stood out: Tiger Balm. Tiger Balm and other compounds containing menthol and camphor have deep roots in eastern medicine, and have historically been used for alleviating pain, cold symptoms, and pruritus in various cultures. However, unlike many of the other analgesic treatments, these compounds are not nearly as recognized in the literature. Consequently, the purpose of this bibliometric study was to analyze current clinical research regarding Tiger Balm and similar topical agents.

Methods:

This study involved a bibliometric analysis of English, peer-reviewed articles indexed in PubMed from 2010 to 2022 using the search term: “‘Tiger Balm’ OR (‘Menthol’ AND ‘Camphor’)”. We identified the journal (and the journal impact factor score), year of publication, study design, clinical relevance, and study topic of each of the resulting articles and discerned underlying trends and themes regarding research on Tiger Balm and Tiger Balm-like compounds.

Results:

The PubMed search resulted in 106 articles, of which 28 (26.4%) articles were deemed clinically relevant research by the authors based on resulting clinical applications. Of all articles, Molecules, Nat Prod Res, and Pest Manag Sci were the most represented, with 4 articles each. Of the clinically relevant articles, each article was published in a unique journal, including Molecules and Nat Prod Res. In regard to Journal Impact Factor (based on Journal Citation Reports), the range for all articles was 0.684 to 14.553, with an average of 3.90, and the range for clinically relevant articles was 0.684 to 8.262, with an average of 3.26. The publication count per year for all articles and for clinically relevant articles demonstrated no obvious trend, with a maximum of 14 total articles in 2021 and a maximum of 4 clinically relevant articles in 2013, 2014, and 2017. Of the clinically relevant articles, study designs included 12 basic science studies, 6 clinical trials, 6 reviews, 1 case series, 1 prospective case control study, 1 retrospective cohort study, and 1 case report. And, of the clinically relevant articles, pain was discussed in only 5 articles, antimicrobial activity in 8 articles, adverse effects in 5 articles, pharmacology in 5 articles, inflammation in 4 articles, pruritus in 4 articles, cold symptoms in 3 articles, circulation effects in 2 articles, and antineoplastic activity in 1 article.

Overall, Tiger Balm and Tiger Balm-like substances have been documented for their topical use for acute and chronic pain, antimicrobial purposes, and cold symptoms relief. Proposed analgesic mechanisms for acute and chronic pain such as knee osteoarthritis⁵, myalgias, neuralgias⁶ include anti-inflammatory effects^7,8 reduction in pain perception^9-13, and improvement in blood circulation^14,15. 

Other benefits of Tiger Balm and similar products include relieving nasal congestion and reducing nighttime cough frequency and severity, improving sleep for both the child and parents.^16-18 Additionally, antimicrobial properties were observed against Streptococcus pyogenes and Candida albicans¹⁹, fluconazole-resistant Candida species²⁰, A. gypsicola²¹, multidrug-resistant Staphylococcus aureus²², Bacillus subtilis, Proteus mirabilis, Listeria monocytogenes, Bacillus subtilis, Escherichia coli, leishmania major²³, onychomycosis²⁴, and Origanum vulgare²⁵.

Potential side effects these topical agents include contact dermatitis²⁶, allergic reactions, skin irritation²⁷, accidental ingestion²⁸, and thiamine deficiency.²⁹

Conclusion:

Based on existing literature, Tiger Balm and other compounds containing menthol and camphor are potentially effective for pain relief in addition to alleviating cold symptoms, relieving pruritus, and functioning as an antimicrobial. However, given the limited number of studies, a definitive, evidence-based recommendation cannot be made in regard to the use of these agents. As such, given the promising results of earlier studies, the authors recommend that more research be done into the clinical application of Tiger Balm and Tiger Balm-like substances as it pertains to pain management, amongst other uses. Specifically, given its popularity in eastern cultures, a literature review of eastern journals that have been published in their native language would be beneficial.

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