RUB­BING IT IN

Health & Nutrition - - ARTHRITIS SPECIAL -

Ap­ply­ing medicine right to where it hurts cer­tainly has a lot of in­tu­itive ap­peal. And for peo­ple whose gas­troin­testi­nal tracts don’t re­act well to NSAIDs (a common prob­lem), or who are re­luc­tant to take pills for what­ever rea­son, the top­i­cal ap­proach is tempt­ing. Here’s a quick run­down of some of the ac­tive in­gre­di­ents in com­monly avail­able top­i­cal pain re­liev­ers.

NSAIDs

What is it? Pain re­liev­ers in the form of gels and oint­ments. How does it work? NSAIDs give ther­a­peu­tic lev­els of the ac­tive in­gre­di­ent (mostly di­clofenac; also ibupro­fen, pirox­i­cam, nimisulide in the af­fected mus­cles/syn­ovial fluid.) What about side ef­fects? The gas­troin­testi­nal prob­lems (stom­ach up­set, ul­cers, bleed­ing) caused by oral NSAIDs are the re­sult of both di­rect ir­ri­ta­tion of the gut’s mu­cosal lin­ing. From what has been seen so far, gels and oint­ments re­sult in lower NSAID blood lev­els than the pill forms of the drugs, which trans­lates into fewer side ef­fects, aside from lo­cal skin ir­ri­ta­tion. Does it work? There are doubts. How­ever stud­ies sug­gest Di­clofenac gel might be mod­estly ef­fec­tive.

METHYL SAL­I­CY­LATE

What is it? A win­ter­green-scented com­pound that’s an ac­tive in­gre­di­ent in many over-the-counter painre­lief oint­ments. Tro­lamine sal­i­cy­late is another sal­i­cy­late used in top­i­cal pain-re­lief med­i­ca­tions. How does it help? When a sal­i­cy­late com­pound is ab­sorbed and me­tab­o­lized into sal­i­cylic acid, it has some ef­fect on pain and in­flam­ma­tion, and stud­ies have found that methyl sal­i­cy­late is well ab­sorbed. A re­cent study came to the con­clu­sion that as­pirin (acetyl sal­i­cylic acid) taken orally and a strong methyl sal­i­cy­late cream were both ef­fec­tive in mak­ing blood platelets less “sticky.” Does it work? Prod­ucts that con­tain methyl sal­i­cy­late might pro­vide some pain re­lief. Tro­lamine sal­i­cy­late hasn’t fared so well in stud­ies. Any­one with an as­pirin al­lergy or who is tak­ing blood thin­ners for car­dio­vas­cu­lar dis­ease should con­sult a doc­tor be­fore reg­u­larly us­ing top­i­cal med­i­ca­tions that con­tain sal­i­cy­lates.

CAP­SAICIN

What is it? A chem­i­cal found in chillies that gives them their hot, spicy taste. Cap­saicin is also the ac­tive in­gre­di­ent in sev­eral over-the-counter pain prod­ucts. How does it help? The burn­ing sen­sa­tion from cap­saicin is sup­posed to do more than just get your mind off the pain, although it does that quite well. In the­ory, neu­rons shut down after they’ve been stim­u­lated by the chem­i­cal, so the burn­ing and other un­re­lated sen­sa­tions – in­clud­ing pain – cease. Does it work? Cap­saicin is poorly ab­sorbed, so the low con­cen­tra­tions in OTC prod­ucts don’t de­liver enough of the chem­i­cal to neu­rons to de­pend­ably pro­duce the de­sen­si­ti­za­tion that is sup­posed to make cap­saicin more than a dis­tract­ing ir­ri­tant. Another prob­lem is that peo­ple are both­ered by the burn­ing sen­sa­tion, so they don’t stick with the treat­ment. High-dose cap­saicin patches have been de­vel­oped, but they re­quire lo­cal or re­gional anes­the­sia and there­fore would only be ap­pro­pri­ate for treat­ment for se­vere chronic pain.

MEN­THOL

How it helps Men­thol’s fa­mil­iar cool­ing sen­sa­tion is the flip side to cap­saicin’s burn­ing, although it’s not ex­pected to “max out” neu­rons and cause de­sen­si­ti­za­tion like cap­saicin. Es­sen­tially, it’s a harm­less sub­stance that cre­ates a pleas­ant di­ver­sion from pain or other ir­ri­ta­tions -- a rea­son­able goal, par­tic­u­larly if it can out­last the pain, but not re­ally a treat­ment for the un­der­ly­ing cause of the pain or in­flam­ma­tion. Cam­phor has a sim­i­lar ef­fect. Does it work? Like cap­saicin, men­thol doesn’t change the skin’s tem­per­a­ture; it cre­ates a cool­ing sen­sa­tion by at­tach­ing to a cer­tain neu­ronal re­cep­tor. Sci­en­tists have found that re­cep­tor in can­cers, so there’s some hope that men­thol could be used to make can­cer treat­ment more ef­fec­tive. File this, though, un­der very pre­lim­i­nary.

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