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Types of Arthritis

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J.R.A.
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Arthritis Treatment the Safe and Natural Way
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Arthritis Surgery


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Arthritis Articles

Facts about Arthritis
Joint Trauma and Osteoarthritis
Arthritis and Depression
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The Role of Sports and Activity in Osteoarthritis
Imaging and Osteoarthritis
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Arthritis Resources
Bursitis
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Topical Analgesics

 

The concept behind topical pain relievers is that it is better to get the medicine directly to the point of pain, through the skin, than it is to ingest it orally and have it diffuse throughout your body potentially causing systemic side effects.  Every medicine has the potential for side effects.  Whether you rub it on, inject it, or swallow it, any medication can have an impact on the body other than the intended therapeutic purpose.  Having said that, getting the medication as close as possible to the site of pathology allows you to accomplish two things.  First, it minimizes the potential for side effects.  Second, it allows you to get a higher concentration of the medicine to the site of pathology than might otherwise have been possible.

 Consider knee arthritis.  If John Doe is suffering from knee osteoarthritis, the best way to get pain relieving medication to the site of inflammation is to inject it directly into the joint.  And, indeed, intra-articular injections are a very powerful way of healing the pain and inflammation of knee osteoarthritis in some patients.  Sometimes, doctors will inject steroid into the knee to reduce inflammation.  Other times, doctors may inject hyaluronic acid to help nourish and lubricate the knee joint.  However, any injection carries with it the risks of bleeding and infection.  Furthermore, injections are painful and, in the case of steroids, cannot be performed indefinitely because the steroid itself is so powerful that too many injections can be harmful.   

For John Doe, suffering with knee osteoarthritis, topical analgesic agents may be the best approach.  Topical agents typically include capsaicin, salicylates, or agents such as menthol, oil of wintergreen, eucalyptus, and methyl sulfonyl methane (MSM).   Capsaicin is a natural ingredient found in cayenne peppers.  Menthol, oil of wintergreen, and eucalyptus all act as counterirritants.  It is not clear exactly how MSM works, but it is speculated that it may impair painful nerve fiber conduction.  Salicylates are compounds found in aspirin.  When taken orally, they act as anti-inflammatory agents by inhibiting certain enzymes.  When applied to the skin, salicylates likely work as counterirritants much like menthol.  In the form that salicylates are applied topically, they often are used as amine derivaties and thus are more likely to be counterirritants. 

Topical agents can be applied via a crème, lotion, or spray.   Some topical agents can feel uncomfortable and noxious.  Some topical agents have a disagreeable odor.  In general, a topical agent that can be sprayed on seems to be preferable.  In addition, a spray that has menthol and eucalyptus is favorable because these products work very well as counterirritants while at the same time feeling good to most people when applied on the skin.  The odor in menthol and eucalyptus is likewise agreeable.  If the topical agent has a natural skin conditioner built in, that is also a plus.  Some clinicians believe that adding an ingredient such as MSM may provide added benefit.  Others argue that the active ingredients in MSM may not adequately penetrate the skin.  Further research in this area is needed.

 Finally, there is research to suggest that topical glucosamine and/or chondroitin may provide pain relief.  In one study published in the Journal of Rheumatology in 2003, patients with knee osteoarthritis were randomized to receive either a placebo cream or a cream containing glucosamine and chondroitin.  The authors found that those patients receiving the topical glucosamine and chondroitin had significantly better reduction in pain at 4 and 8 weeks than did those receiving the placebo cream.  Cohen M, Wolfe R, Mai T, et al.A randomized, double blind, placebo controlled trial of a topical cream containing glucosamine sulfate, chondroitin sulfate, and camphor for osteoarthritis of the knee.J Rheumatol 2003;30:523–8. 

 Oral agents, by contrast, with topical and injectable agents, have a much higher risk of side effects.  Oral nonsteroidal anti-inflammatory medications such as Ibuprofen (Advil) carry risks of stomach bleeding, renal problems, and other potential side effects.  In some patients, with chronic pain, oral medications may be a good alternative.  However, particularly in cases of acute pain, or a flare up of chronic pain, topical analgesics, particularly those discussed in this article, should be considered as first line agents after a careful discussion of all of the pros and cons of all medications is had with your individual doctor. 

Importantly, topical analgesics in any preparations should never be placed on open wounds.  They should not be used prior to a consultation with your doctor.  Pregnant women, women who may become pregnant, and people with serious medical conditions should all be extra certain to have a discussion with their physician prior to starting any medication, including a topical medication.  While a topical medication does not typically get absorbed systemically as much as an oral agent, it is not clear how much of the topical medication does get absorbed.  The most important step in treatment is always arriving at an accurate diagnosis and then formulating a treatment plan based on your individual risks and goals so that the treatment best fits your needs. 

 

 

 

 

 

 Arthritis MD. © 2005