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Arthritis Special Report

Pain Relief for Arthritis With Topical Analgesics

Johns Hopkins Health Alerts Arthritis Relieving Back Pain with Capsaicin

Topical analgesics are nonprescription products that you apply to the skin over an aching joint to provide temporary pain relief. They can be useful for people with mild to moderate osteoarthritis pain who experience inadequate pain relief with Tylenol or wish to avoid the side effects of oral pain relievers.

The three main types of topical analgesics for pain relief are counterirritants, salicylates, and capsaicin; combination products for pain relief are also available. These include ArthriCare, BenGay, Flexall 454 Ultra Plus Gel, and Icy Hot Chill Stick. They are usually sold as creams, gels, or ointments that are gently rubbed into the skin, but sprays and patches are also available.

Topical nonsteroidal anti-inflammatory drugs (NSAIDS) such as ketoprofen, felbinac, ibuprofen, and piroxicam are popular in the United Kingdom and other parts of Europe, but have yet to be approved by the U.S. Food and Drug Administration.

  • Pain Relief With Counterirritants
    These pain relief preparations (which include Flexall 454 Maximum Strength Gel and Therapeutic Mineral Ice) contain such ingredients as menthol, camphor, eucalyptus oil, and turpentine oil. When applied to the skin over an affected joint, they mask pain by producing a warm or cool sensation. Counterirritants can be applied to the skin three or four times a day. A frequent side effect is reddening of the skin, which is harmless and temporary.

  • Pain Relief With Salicylates
    Oral salicylates (aspirin) and topical salicylates, such as trolamine salicylate or methyl salicylate, reduce pain and inflammation by inhibiting the release of prostaglandins. An analysis in the British Medical Journal concluded that topical preparations (which include Aspercreme and Sportscreme) relieve pain more effectively than a placebo, but it is unknown how they compare with oral pain medications.

    Salicylates can be applied to the skin up to four times a day. Because some of the medication is absorbed into the body, people who are sensitive to aspirin or other salicylates or are taking medication that might interact with them—for example, warfarin (Coumadin)—should use these creams with caution. If you experience any symptoms of salicylate toxicity, including ringing in the ears, blurred vision, and shortness of breath, you should report them to a doctor.

  • Pain Relief With Capsaicin
    Perhaps best known as the compound that gives hot peppers their “bite,” capsaicin reduces the amount of a neurotransmitter called substance P, which is thought to release inflammation-causing enzymes and possibly trigger pain impulses to the brain.

    The ointment should be applied to affected joints three or four times a day. It usually takes one to two weeks for pain to diminish, although up to six weeks of treatment might be required for maximum benefit. Pain quickly returns after capsaicin is discontinued. Burning, stinging, and redness occur in 40% to 70% of people, but these side effects usually diminish after several days of use.

    Over-the-counter products containing capsaicin include Capzasin-HP, Capzasin-P, Zostrix, and Zostrix-HP.

If You Use a Topical Treatment for Pain Relief
Topical treatments for joint pain relief are not dangerous and have few side effects, but some precautions apply. The medications are for external use only and should not come in contact with the eyes, nose, mouth, or any open skin.

The products shouldn’t be used more than three or four times a day and should be discontinued immediately if severe irritation develops. If symptoms do not improve after seven days, most manufacturers recommend discontinuing the product and seeing a doctor. In addition, many of the products come with warnings not to bandage or apply heat to a treated area.

Some topical preparations also contain glucosamine or chondroitin, but there is no evidence that these compounds have any effect on osteoarthritis when applied to the skin. A randomized controlled study of 63 people, published in The Journal of Rheumatology, found that one such preparation was more effective than a placebo in providing pain relief of knee osteoarthritis within four weeks. However, the effect was most likely explained by the product’s active ingredient: camphor.

Posted in Arthritis on February 7, 2006

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