Arthritis pain: Treatments absorbed through your skin

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Arthritis pain: Treatments absorbed through your skin

After an especially active weekend of hiking or work around the yard, your joints might continue to hurt even after you take your usual arthritis pain medication. Reluctant to pop another pill, you may decide to pick up an over-the-counter joint cream or patch that promises to dull the pain.

But how do these products work? Are they any good at relieving arthritis pain?

What are topical pain medications?

Topical pain medications are absorbed through your skin. The most common varieties are creams or gels that you rub onto the skin over your painful joints. Some types come in the form of a spray or a patch that sticks to your skin. Because the ingredients are absorbed through the skin, most topical pain medications are best used on joints that are close to the skin's surface, such as the joints in your hands and knees.

What types of ingredients are used?

The active ingredients in over-the-counter topical pain medications may include:

  • Capsaicin. Capsaicin (kap-SAY-ih-sin) causes the burning sensation you associate with chili peppers. Capsaicin creams deplete your nerve cells of a chemical that's important for sending pain messages. Examples include Capzasin and Zostrix.
  • Salicylates. Salicylates (suh-LIS-uh-lates) contain the pain-relieving substance found in aspirin. Examples include Aspercreme and Bengay.
  • Counterirritants. Substances such as menthol and camphor produce a sensation of hot or cold that may temporarily override your ability to feel your arthritis pain. Examples include Icy Hot and Biofreeze.

How well do they work?

Opinions differ on the effectiveness of over-the-counter topical pain medications. While many people say these products help relieve their arthritis pain, scientific research reveals only modest benefits. Some products work no better than placebo in relieving arthritis pain. Salicylates appear to be more effective for muscle aches, while capsaicin products are more often used for pain associated with damaged nerves — such as postherpetic neuralgia.

Are they safe to use?

Application of capsaicin creams can make your skin burn or sting, but this discomfort generally lessens within a few weeks of daily use. Wash your hands thoroughly after each application and avoid touching your eyes and mucous membranes. You may need to wear latex gloves when applying the cream.

If you are allergic to aspirin or are taking blood thinners, check with your doctor before using topical medications that contain salicylates. Don't use topical pain relievers on broken or irritated skin or in combination with a heating pad or bandage.

Are there topical pain products available by prescription?

Pills containing nonsteroidal anti-inflammatory drugs (NSAIDs) are a common treatment for osteoarthritis, but they can irritate the stomach. In Europe, many doctors prescribe NSAID creams or gels because they have a lower risk of stomach irritation. Some studies indicate that many NSAID creams and gels work as well as their oral counterparts.

In the United States, the Food and Drug Administration has approved several topical products (Voltaren, Pennsaid, others) that contain the prescription NSAID diclofenac for the treatment of osteoarthritis in joints close to the skin's surface, such as the hands and knees.

In some cases, doctors may prescribe patches containing a numbing medication, such as lidocaine (Lidoderm), for joint pain. The patches are approved in the U.S. to treat a painful complication of shingles, but they may be used for other types of pain — what is called an off-label use. Patches are placed on your skin over the painful joint for 12 hours at a time.

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