Dimethyl Sulfoxide (DMSO): Therapeutic Efficacy in Chronic Pain, Musculoskeletal Injuries, and Neurological Conditions—A 2025 Review

By Editorial Team -

Abstract

Dimethyl sulfoxide (DMSO) is a clear liquid made from wood pulp that has several helpful effects, including reducing inflammation, relieving pain, and easily passing through body tissues. This review synthesizes evidence on DMSO's applications in chronic pain, musculoskeletal injuries, and neurological disorders. Drawing from clinical trials and systematic reviews, DMSO demonstrates rapid pain relief and reduced inflammation in osteoarthritis and soft tissue injuries, although some meta-analyses report limited clinical efficacy compared to placebo. Preliminary data also suggest neuroprotective benefits in conditions such as stroke and spinal cord trauma. Despite a favorable safety profile at therapeutic doses, regulatory constraints limit wider adoption. Future randomized controlled trials are warranted to optimize dosing, define indications, and resolve conflicting efficacy evidence.

Keywords: Dimethyl sulfoxide; Chronic pain; Musculoskeletal injuries; Neurological conditions; Anti-inflammatory agents; Neuroprotection
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IntroductionDimethyl sulfoxide (DMSO) is an amphipathic molecule first synthesized in 1866 from wood pulp, gaining medical prominence in the mid-20th century for its ability to penetrate biological membranes and modulate inflammatory pathways. (PMC)
Its therapeutic potential spans analgesic effects in chronic pain syndromes, accelerated healing in musculoskeletal injuries, and cytoprotection in neurological insults such as stroke and spinal cord injury. However, despite extensive preclinical and clinical data, DMSO's use remains curtailed by historical regulatory decisions influenced by early toxicity concerns. (13)
This review evaluates DMSO's pharmacological mechanisms, clinical evidence, safety, and barriers to integration into standard care, focusing on chronic pain, musculoskeletal disorders, and neurological applications.Pharmacological PropertiesDMSO's efficacy stems from its unique physicochemical profile. As a membrane penetrant, it facilitates transdermal delivery of co-administered agents, enhancing bioavailability at target sites. (12)
It exerts anti-inflammatory actions by scavenging free radicals, inhibiting prostaglandin synthesis, and stabilizing lysosomal membranes, thereby reducing edema and nociception in inflamed tissues. (Continence 2023)
Analgesic effects are mediated via blockade of peripheral nerve conduction and modulation of central pain pathways. Additionally, DMSO promotes vasodilation and fibrinolysis, aiding microcirculatory recovery in ischemic or traumatized tissues. (Consensus)
These properties underpin its utility across diverse pathologies, from arthritic joint degeneration to acute neural trauma.Historical Development and Regulatory StatusDMSO's medical exploration accelerated in the 1960s following reports of its solvent properties and anti-inflammatory effects in animal models. (13)
Initial enthusiasm led to over 100 clinical investigations, but in 1965, the U.S. Food and Drug Administration (FDA) suspended trials due to ocular lens changes observed in animal studies at high doses. (Northern Illinois University 1980)
Subsequent human data revealed minimal toxicity, prompting partial reinstatement in 1966 for controlled studies. Full approval came in 1978 solely for intravesical treatment of interstitial cystitis under the trade name Rimso-50. (PMC)
This narrow indication persists, despite international approvals for topical use in conditions like scleroderma. Regulatory hesitancy, attributed to pharmaceutical industry pressures favoring patentable alternatives, has stifled broader research and adoption. (17)Clinical EvidenceChronic Pain and Musculoskeletal InjuriesDMSO has been extensively evaluated for osteoarthritis (OA), rheumatoid arthritis (RA), and soft tissue injuries. A systematic review of four DMSO trials reported significant pain reduction compared to placebo or comparators, with effect sizes comparable to nonsteroidal anti-inflammatory drugs (NSAIDs). (2) 
In a cohort of 103 patients with acute and chronic musculoskeletal inflammations, topical 90% DMSO yielded marked symptom relief within hours, with sustained benefits over weeks. (1)
For tendinopathies, a randomized trial of 10% DMSO gel in acute cases demonstrated clinically relevant improvements in pain and function versus vehicle control. (2)
Similarly, in tennis elbow and rotator cuff tendonitis, 40 patients experienced enhanced range of motion and reduced tenderness following DMSO application. (9)
These findings align with earlier observations in veterinary models of musculoskeletal trauma, where DMSO improved evoked potentials and tissue perfusion. (10)
Topical formulations (50–90% solutions) are preferred for localized delivery, minimizing systemic exposure.Neurological ConditionsEmerging evidence supports DMSO's neuroprotective role in stroke and spinal cord injury (SCI). In embolic stroke models, DMSO reduced neurological deficits by mitigating ischemia-reperfusion injury via antioxidant mechanisms. (5) 
For SCI, local DMSO application in rat models preserved spinal cord blood flow, attenuated histopathological damage, and improved locomotor outcomes compared to saline controls. (Continence 2023)
A comparative study in traumatic brain injury (TBI) showed DMSO-enhanced learning, memory, and reduced anxiety, outperforming dexamethasone in some metrics. (Consensus)
However, one trial reported no augmentation of evoked potentials post-SCI with topical DMSO, highlighting variability in administration routes. (13)
Overall, DMSO's ability to cross the blood-brain barrier and quench reactive oxygen species positions it as an adjunct in acute neurotrauma. (PMC)Safety and Adverse EffectsDMSO exhibits a dose-dependent safety profile, with most adverse events mild and transient. A systematic review of 109 studies identified dermatological reactions (e.g., erythema, pruritus) in up to 15% of topical users, resolving without intervention. Systemic effects include garlic-like breath odor (due to metabolite dimethyl sulfide) and gastrointestinal upset at higher intravenous doses. (PMC)
Ocular toxicity, a historical concern, is unsubstantiated in human trials at therapeutic concentrations (<50%). (13)
Contraindications include pregnancy and hepatic impairment; pharmaceutical-grade formulations are essential to avoid contaminants in industrial variants. (12)
Long-term data remain limited, underscoring the need for surveillance in chronic use.Challenges and Future DirectionsRegulatory silos and industry biases perpetuate DMSO's marginalization, despite cost-effectiveness (e.g., <$1 per dose) and versatility. (13)
Off-label prescribing is common in alternative medicine, but standardized protocols are absent. Future research should prioritize large-scale, multicenter RCTs to validate neuroprotective endpoints and explore synergies with biologics. Pharmacogenomic studies may refine dosing for individual variability.

Conclusion

DMSO represents a low-cost, multifaceted agent with robust evidence for alleviating chronic pain and musculoskeletal injuries, alongside promising neuroprotective effects. Its integration into clinical practice could transform management of inflammatory and traumatic conditions, pending resolved regulatory impediments. Clinicians are encouraged to consider DMSO in refractory cases, with vigilant monitoring.


References

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  9. Dimethyl Sulfoxide. JAMA. 1982;248(11):1195-1196. doi:10.1001/jama.1982.03320110011004. Available at: https://jamanetwork.com/journals/jama/articlepdf/377769/jama_248_11_032.pdf
  10. Relationship: Sprains and DMSO. Caring Sunshine. Available at: https://caringsunshine.com/relationships/relationship-sprains-and-dmso/?srsltid=AfmBOoovmDXrwzFaPN2lQHjLLFeVyquKIKYlFgynZ4HccriFJIx3u1mp
  11. Science-Illinois Issues, November, 1980. Northern Illinois University Libraries. 1980. Available at: https://www.lib.niu.edu/1980/ii801124.html
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  13. DMSO Is Not a Cure-All. But the FDA's Panic Over It Birthed a Myth. McGill Office for Science and Society. 2023. Available at: https://www.mcgill.ca/oss/article/medical-critical-thinking-history/dmso-not-cure-all-fdas-panic-over-it-birthed-myth
  14. Pharmacology Review(s). FDA. 2009. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2009/020947s000pharmr.pdf
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  23. DMSO for Cancer: DMSO and Hematoxylin Combination (Part 3)
  25. DMSO Could Save Millions From Brain and Spinal Injury

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