Drugs such as aspirin and Advil taken orally are often helpful for pain, but they have lots of side effects. For example 107,000 patients are hospitalized each year due to GI complications from these types of drugs and around 16,500 die. These drugs can be dangerous particularly with long term use and are even more so in older patients. The good news is that in some cases these medicines work just as well when applied topically, with very little or no side effects. Because the medicine is applied where it is actually needed the systemic level is very low, making it much safer.
How well do topical NSAIDs work?
A recent scientific review by the Cochrane Collaboration, an international body of health experts, found that some prescription topical NSAIDs offer the same pain relief as oral medications, but with fewer gastrointestinal concerns. The Cochrane review covered 34 studies involving 7,688 adults who experienced chronic musculoskeletal pain for at least three months. They received several different kinds of topical NSAIDs for their pain. Topical diclofenac (Voltaren) was as effective as oral diclofenac for arthritis in the knee or hand.
Topical Diclofenac is only available by prescription as Voltaren Gel, Pennsaid or the Flector Patch. Voltaren gel is the least expensive and seems to be covered by many insurance plans, and is well liked. Pennsaid comes in their new twice a day pump bottle which is a lot more convenient than their old product. I like it a little more than the Voltaren Gel but it is not covered by as many insurance companies and is more expensive. Anybody with knee pain should try either Voltaren gel or Pennsaid. We usually have samples for office use and it takes about 5 minutes to find out if it helps. There are no OTC diclofenac products. Let us know if you want to try one of these products.
Do you need a little extra help with your pain?
Perhaps a sore shoulder or a throbbing elbow? Or maybe your knees?
Put the medicine where the pain is.
Patients are often surprised to find out how effective topical pain medicines are. Even many of the OTC products advertised on TV have been shown to relieve chronic pain. Some benefits of topical medicines include:
Little or no side effects.
Often very inexpensive
In some cases more effective than oral medicine.
Aspercreme is OTC and has been around for years, and for good reason: it works, it's inexpensive compared with other remedies, and it doesn't smell, although it's a bit greasy. Don't use it if you're allergic to aspirin or other salicylates.
Methyl salicylate 10% is in a number of topical products.
Salonpas has 12 hour patches, gels, lotions and sprays with various combinations of methyl salicylate, camphor and menthol. The products are inexpensive, widely available at any drugstore and well liked.
Zostrix contains capsaicin which is what gives pepper their fire. Rubbing it on the skin depletes substance P which prevents pain messages from being sent. It does not cause numbness but does decrease pain. Best effects come after it builds up, so use it consistently for a couple of weeks before judging its effectiveness. Zostrix is a good brand but there are many other brands to pick from as well.
Australian Dream is widely available at most drug stores, and comes with an empty bottle guarantee. If you aren’t happy with it they refund your money. It is not an NSAID or capsaicin, so it is in a category all by itself. I have talked to many people who swear by it as an effective product.
Comfrey ointment is an excellent product for sore backs, sore joints, arthritis, etc. Kytta-Salbe and Traumaplant are the two best brands, and I recommend either one. All of the studies below were done with one of these two brands.
Back Pain- A new study in the British Journal of Sports Medicine included 120 volunteers who were divided into 2 groups. One group received the comfrey root (Kytta-Salbe) ointment and the other utilized a placebo (inactive) ointment. All of the volunteers applied 4 grams of the respective ointments on the pain site, three times daily for a total of 5 days. Neither the researchers nor the participants knew which ointment they were using until after the completion of the trial. This is referred to as a “double blind, placebo controlled study” and is considered the gold standard of scientific experiments.
The back pain was reduced by 95% in the comfrey ointment users. Those applying the placebo reported pain reduction of only 38%. The pain relieving effect of the topical comfrey was apparent within a one hour time frame.
Find the product that works for you. We have just touched the surface on topical pain medicines. There are literally hundreds of topical products. Many are effective and inexpensive, and can help you to have a better quality of life. Every patient with chronic pain should try a number of topical products, and find the ones that work the best for them. The potential benefits are just too great to ignore. We have samples of many of the products that you can try.
Traumeel is an old standby and is highly effective at treating injured or sore muscles, ligaments and tendons. It is truly the athlete's friend.
Traumeel consists of 14 natural ingredients including Arnica, and is used for treating the pain of sports injuries, repetitive use injuries, sprains, backaches, muscle aches and bruises.
Traumeel is backed by dozens of scientific and clinical studies. For example a double blind, placebo controlled study showed that sprained ankles heal in about half the time if treated with Traumeel. Traumeel will help you recover from sore muscles, bruises, sprained backs, necks, or ankles. Any new injury should be treated with Traumeel, unless there is broken skin. It is a safe and effective formula recommended by doctors in over 60 countries worldwide. Traumeel is an essential addition to at-home healthcare. No household should be without Traumeel.
When I go out and spend the weekend on the snowmachines and come back with throttle thumb, this is what I use. When I get stuck too many times and my low back is painful from doing all the heavy lifting, I look for the Traumeel.
Look for this on Amazon.com
Muscle pain: A 2005 trial found similar results in a group of 215 people with lower and upper back muscular pain (myalgia). In that experiment, the researchers found “highly relevant” reductions in inflammation and pain. They also concluded that the comfrey ointment was fast-acting and well tolerated.
Ankle sprains: Three recent trials involving approximately 500 participants concluded that comfrey ointment was beneficial in the management of ankle sprains. One such study even found that comfrey outperformed a conventional medication (diclofenac), which is a non-steroidal anti-inflammatory drug (NSAID) used to reduce acute inflammation and pain. It’s also worth noting that the tolerability of the comfrey preparations was deemed as excellent.
Arthritis: A 2007 study in the journal Phytomedicine reported that applying 2 grams of comfrey ointment 3 times a day helped reduce the symptoms of osteoarthritis of the knee, leading to an improvement in mobility and quality of life, in addition to a reduction in pain.
Most pain relieving medications aren’t intended to hasten healing time. A German trial from 2007 indicates that comfrey may be an exception to this convention. A trial involving 278 patients with “fresh abrasions” found a “highly significant and clinically relevant” reduction in wound size in those applying a comfrey-based ointment (as compared to a placebo ointment). The effects were evident after only 2-3 days.
Allantoin - the active component in comfrey - stimulates cell proliferation and promotes regeneration of damaged connective tissue. Because of the allantoin, comfrey ointment not only relieves pain, but also stimulates healing and strengthening of the injury.
Kytta-Salbe and Traumaplant are both hard to get in the US, but I have found both of them on Amazon.com.
Directions: Apply generously to affected areas 2 to 3 times daily. Traumeel should be rubbed gently into the skin. Traumeel may be applied using mild compression bandaging and/or occlusive bandaging. Sufficient gel should be applied to cover the affected area, but should not be applied over large areas, over broken skin or directly into open wounds.
A compounded drug is made up by a pharmacist according to a specific recipe from us. The advantage of compounded topicals is that we can combine several classes of drugs into the same gel. For example we can combine a local anesthetic (think of the lidoderm patch) with an NSAID (think about Voltaren gel) and a nerve specific drug (perhaps amitriptyline). Some of the compounded formulas we use are highly effective, but the disadvantage is that they are very expensive. So expensive that if you do not have insurance, you probably do not want to consider this option.
Topical Medicines that require a Prescription.
Lidoderm patches are placed on the painful area for 12 hours of each day. The lidocaine (Novacaine) soaks into the skin and is released slowly, so even though you remove the patch after 12 hours it continues working around the clock. These patches are by prescription only, but should be less expensive now that there is a generic patch available.
Lidocaine gel 5% is also a prescription product, but is generic and very inexpensive. Apply this topically 2-3 times a day, but do not exceed 5 grams or a 6 inch strip of ointment per dose; or 20 grams of ointment per day. We have been pleased with the positive results many patients have reported.
Topical Pain Medicines that do NOT require a Prescription.
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