Friday, March 29, 2024

Creams that help arthritis pain

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My friend Steve plays acoustical guitar, both 6-string and 12-string. We met over 40 years ago at a church-sponsored retreat. We still sing together at our Saturday evening church service. Now that we are in our mid-60s, our bodies are showing some wear and tear.

Some days, Steve has trouble playing guitar because his knuckles feel tight or stiff. Last week he asked me what he could do to relieve the stiffness.

“Should I try some CBD?”

"Well, CBD cream or gel might help, but it's pretty expensive compared to other options you could try first. Does a heating pad help your hands loosen up?"

“Heat helps, but is there something I can rub on my hands?”

There are several non-prescription products Steve could try. Methyl salicylate, camphor, menthol, eucalyptus, capsaicin are derived from natural sources. These products have been used for decades to treat aching muscles and stiff joints. These agents work locally instead of affecting your entire system. They can be added to other pain relief strategies, like taking painkillers like Tylenol® (acetaminophen), ibuprofen and naproxen without risking toxicity or overdose.

Methyl salicylate, camphor, menthol, and eucalyptus work as counterirritants. Instead of calming or blocking nerves to relieve pain, a counterirritant gives you relief by triggering sensory nerves in your skin. This creates feelings of intense warmth or soothing coolness while at the same time keeping those nerves too busy to recognize painful sensations.

Counterirritants also create redness and warmth from increased blood flow to the area caused by inflammation, similar to using a heating pad. Mustard plasters of the past work by doing this. Applying a mustard slurry to your chest for 15-20 minutes will create redness, warmth, and increased blood flow to that area for up to 48 hours afterward. It's essential to remove a mustard plaster promptly because it will cause blistering and severe burns if left on for more than 20 minutes.

Counterirritants commonly used include methyl salicylate, which is wintergreen oil, its odorless cousin, trolamine salicylate, camphor, and menthol, which is extracted from peppermint oil.

Topical pain relievers often have more than one counterirritant. Although Mineral Ice® contains menthol as its sole ingredient, Tiger Balm® Arthritis Rub has both menthol and camphor, and Ben-Gay® Ultra Strength Pain Relieving Cream contains methyl salicylate, menthol, and camphor. If Steve doesn't want to smell like a breath mint, he could choose the odorless Aspercreme® formula instead, containing trolamine salicylate.

Most non-prescription pain relief creams and gels contain one or more counterirritants, but Steve has another option. Capsaicin is derived from hot chili peppers and works by triggering a nerve messenger called Substance P in the skin where you apply it. Substance P’s job is to transmit messages to your brain that there’s pain. When Steve applies capsaicin to his painful knuckles, it will flush out Substance P. Until his body builds up more Substance P, his nerves can't tell his brain that his knuckles hurt.

When Steve applies capsaicin for the first time, he will notice a moderately intense burning and tingling sensation. This is followed by diminished pain for several hours, giving Steve 8-10 hours of pain relief.

The initial burning and tingling feeling are from the release of Substance P. As his body builds back its Substance P, Steve will eventually start feeling tingling and burning again. If he reapplies capsaicin, he'll enjoy another stretch of pain relief.

Capsaicin is extracted from pepper, so make sure to wash your hands after applying it. If you rub your eye with capsaicin on your finger, you will notice it! To avoid this, I recommend using a roll-on applicator of capsaicin.

5 Tips for Using Topical Non-Prescription Pain Relievers:

1.They are best suited for small areas that are easy to reach.

Small areas that you can easily reach are good choices to add a counterirritant for occasional discomfort or breakthrough pain.

2.Avoid broken skin and cover loosely, if at all.

Counterirritants work by causing irritation. They can cause burns, even blisters if applied to sensitive or broken skin.

3.Camphor can create either a warming or cooling sensation.

Camphor causes both a cooling sensation when gently applied, but warmth when rubbed into your skin.

4.Apply capsaicin with a roll-on stick.

Applying capsaicin with a roll-on stick keeps the pepper-based extract from chili peppers from ending up on your fingers or inadvertently in your eyes.

5.Reapply capsaicin when you first notice tingling or burning.

Reapplying capsaicin promptly keeps Substance P from building up and you much more comfortable.

Dr. Louise Achey, Doctor of Pharmacy, is a 42-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog TheMedicationInsider.com.

_2021 Louise Ache

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