Topical Medications

Not every treatment for arthritis is a pill or an injection. There are creams, gels, ointments, balms, and lotions that can be rubbed into the skin over the affected joint. Some help to relieve pain, while others work on inflammation.

The topical products are available over-the-counter and have one or more active ingredients. By rubbing into the joint locally, topical products have less risk for systemic side effects.

Topical Counterirritants

Counterirritants stimulate or irritate the nerve endings to distract the brain and take attention off of musculoskeletal pain. Menthol, oil of wintergreen, camphor, eucalyptus oil, turpentine oil, dihydrochloride, and methyl nicotinate are ingredients found in the brand-name products ArthriCare, Eucalyptamint, Icy Hot, and Therapeutic Mineral Ice.

Fact

The American College of Rheumatology acknowledges the role of topical agents in the treatment guidelines for osteoarthritis. Patients who have mild pain, but do not get enough help from Tylenol alone, may be candidates for topical medications.

Topical Capsaicin

Capsaicin works by depleting the amount of a neurotransmitter called substance P that sends pain messages to the brain. Capsaicin is a highly purified product derived from cayenne peppers. Burning or stinging may be noticed with initial use. Topical products that contain capsaicin are sold as Zostrix or Zostrix HP and Capzasin-P, among others. It is very important to avoid the eyes because topical capsaicin can cause burning.

Topical Salicylates

Salicylate topical products work as oral salicylates do — by inhibiting prostaglandins. They also work as counterirritants. Topical salicylates are sold under the names Aspercreme, BENGAY, Flexall, Mobisyl, and Sportscreme.

Topical NSAIDs

Topical NSAIDs contain diclofenac and are sold in some countries as Pennsaid lotion. Research has shown the benefit of topical NSAIDs to be short-lived. In one study, topical NSAIDS offered better pain relief than the dummy treatment for the first two weeks, after which it was no more effective than the dummy treatment. Topical NSAIDS were less effective than comparable oral NSAIDS, even in the first two weeks. Local compounding of the agent at a higher dose may increase efficacy.

Topical Agents with MSM or Glucosamine

MSM and glucosamine, besides being dietary supplements, are found in topical creams and gels. There have yet to be studies that prove their effectiveness when compared to oral MSM and oral glucosamine.

Before trying topical agents, talk to your doctor. Discuss whether they are safe for you to use. Also inquire whether you should continue using them past a certain point if benefit is not noticeable. Ask which topical agent your doctor would recommend, as well as questions about how and when to apply the topical preparation. It's your decision and your money, but a well-informed decision is best.

Clearly, the best candidates for topical medications are those patients who are unable to take oral medications for one reason or another; it may be worth a trial in such cases. There is no cure for arthritis in a tube of cream. You are aiming for mild pain relief at best. Don't write it off as nothing until you try the products, but at the same time don't hope for too much.

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