Topical analgesics are a growing area of clinical interest, given improvements in formulation drug delivery and local delivery of medicine, limiting risk for potential adverse systemic effects. Topical analgesics include medications for acute and chronic pain, such as musculoskeletal pain disorders, including sprains and strains; neuropathic pain; and muscle pain related to trauma. This review covers an update on formulations for acute and chronic pain, a discussion on advancements in drug delivery, and an update on recent treatment guidelines related to topical medications for osteoarthritis and neuropathic pain conditions.