Icy Hot. Ben Gay. Tiger Balm. These are just a few of the many over-the-counter topical (meaning, applied to the skin) pain relieving products (TPRPs) on the market. They vary by type, and of course active/ therapeutic ingredients.
There are also prescription TPRPs that contain medications like ibuprofen, aspirin or opioid derivatives (Rx TPRPs are not necessarily more effective than OTC ones).
These products generally are OK for aches and pains affecting muscles, tendons, joints and sometimes nerves; not so much for acute injuries involving swelling. And, they are effective only for superficial areas such as elbows and wrists, as depth of penetration is limited.
So far, research shows some benefit in reducing pain, but nothing dramatic. Anecdotal evidence on their effectiveness obviously differs wildly from person to person. This is mostly due to the fact that pain has both physical and mental components to it, and different people perceive pain differently.
Topical pain relief products come in creams, gels, ointments, patches and sometimes sprays. They are usually manufactured with a “delivery agent,” a substance that binds to the active ingredient and penetrates the skin where it diffuses down to the target tissue. The delivery agent, therefore, is critical to the products potency.
There are three basic ways TPRPs work:
(1) analgesia – reducing inflammation
(2) nerve signal inhibition
(3) counter-irritant
The medicinal products use analgesia to reduce pain; this includes those that contain ibuprofen or aspirin (acetylsalicylic acid). Botanicals such as arnica, boswellia serrata, devil’s claw and comfrey are herbs associated with pain relief and are found in many TPRPs. Their mechanism of action is probably via inflammation reduction by acting as a blocking agent in inflammatory reactions.
Capsaicin is the compound that gives hot peppers their perceived heat. Products utilizing this as the active ingredient are more suited for nerve-related pain (neuralgias) like post-herpetic neuralgia, trigeminal neuralgia or a peripheral nerve entrapment condition like carpal tunnel syndrome. What it does is bind to the ends of nerves that send chronic (slow) pain signals which causes them to discharge their neurotransmitter substance P (the substance that transfers the pain signal from nerve cell to nerve cell along the nerve) until it is depleted, effectively deadening the nerve temporarily.
The counter-irritants use menthol and/or camphor, substances that seem to affect cold receptors in the skin. Like ice, it sends a cooling sensation to the brain which may “scramble” or interfere with the pain signal coming from the painful area, thus reducing the perception of pain even though the skin temperature remains the same. Rubbing a sore wrist is basically the same thing — creating more nerve signals (pressure, friction) to compete with the pain signals, thus diluting their impact.
So should you try topical pain relief products? The obvious benefit is that they target only the area of pain. With oral pain relief medications, Rx and OTC, the reach is systemic as the medication is delivered in the blood stream to all body tissues except the brain. This creates a new set of problems (side effects) like nausea, muscle cramps and even renal damage.
On the other hand topical pain relief products don’t reach the target area as well as oral medications. The skin is designed to be impregnable to most external substances, so even if the medicine is able to penetrate, it is at a much lower dosage. This is significant only for the analgesic TPRPs, as they have to reach all the way down to the painful tissue. With the counter-irritants, penetration is not so much an issue as they work on sensory nerve endings that are close to the surface of the skin.
One product that I ran across seems to be effective for a lot of people, at least anecdotally, based on its reviews. It is called Penetrex and contains arnica, boswellia extract, MSM, vitamin B6 and a special delivering agent. If you have chronic pain affecting tendons, muscles and/or superficial joints, it’s worth giving it a try. As a matter of fact, it wouldn’t hurt to try the different TPRPs you find OTC at your nearest drugstore; it’s preferable to oral pain relief products (pills, tablets and liquids) any day, as far as safety is concerned.
Russian kettlebell exercises are a great way to strengthen and condition your pelvic stabilizers, promoting a strong back that is less prone to movement-caused injury.
The pelvic stabilizers consist of all the muscles connected to the pelvis working in synergy to enable you to lift, push and carry (perform work). They include:
Erector spinae group (quadratus lumborum, multifidi, rotatores, iliocostalis)
In this video, I demonstrate the proper form for doing these exercises:
Think of your pelvis as a powerful hinge; a “bio-mechanical hub” that connects your torso to your legs. The pelvis’ engineering enables you to stand upright and bear a load by serving as an anchor/ attachment point (resistance-counter force) for the muscles performing the work. It is truly a biological marvel and should be targeted for exercise so that one can meet the physical demands of life more easily.
Examples of common activities that heavily rely on pelvic stabilizers:
Standing up from a seated position; sitting from a standing position
Bending down and lifting something from the ground
Putting your carry-on luggage in the overhead bin of an airplane
Lifting up a child
Throwing a football
Jumping across a puddle
The exercises involve moving a kettlebell, which resembles a cannon ball with a large hand grip, by using the power generated from pelvic thrusting. The repeated thrusts are created by alternating antagonist-agonist* function of the pelvic stabilizers.
*Muscles work in pairs. The muscle that is undergoing a concentric contraction (getting shorter as it contracts) is called the agonist while its counterpart, referred to as the antagonist offers stabilization and measured control of the movement. Muscles switch from being agonist to antagonist and vice versa, depending on the movement. Examples: biceps-triceps, quadriceps-hamstrings.
Although it looks like the arms are involved due to their obvious swinging motion, they are actually not being exercised. The arms serve to connect the weight to the pelvis structure, like a piece of rope. The kettlebell “drags” your arms with it and moves via inertia after being propelled by the rhythmic pelvic thrusts.
Initiate the thrust with your leg muscles, driving power through your feet and channeling it into your pelvis and core to swing the weight forward. Do not use your arm muscles to swing the weight, and try to keep your lower back straight. The worst thing you can do is put too much load on your lower back muscles in the flexion position– this can cause a severe back injury, so avoid doing this.
The benefit of developing your pelvic stabilizer muscles’ strength and coordination is that it will be much easier to move your body; to make it do work. Going up stairs, getting out of and into your car seat, and lifting and carrying heavy things will be much easier. You’ll be pleasantly surprised!
Kettlebell exercises burn up a lot of calories, so they are also good for weight loss.
Remember to use good form and start out with a light weight, working your way up as you develop muscle strength and coordination. Kettlebells can be as light as 2 pounds and as heavy as 50 pounds. The one I am using in the video is a solid 40 pounds.
I am constantly looking for topics on pain and pain management to address on this blog for the benefit of my readers. When it comes to pain, numbness and other abnormal sensations, it understandably is a cause for concern, especially for cases where the diagnosis is not clear or certain.
I know that some of you have already seen your doctor, but are not satisfied with the answer you received. Maybe your doctor unintentionally trivialized your complaint, saying it would work itself out over time. But in your mind you did give it enough time, and it’s still there.
Or perhaps you are getting physical therapy, chiropractic, massage or acupuncture, but your symptoms remain. Be aware that pain appearing as musculoskeletal in origin (sprain, strain, arthritis, pinched nerve, fracture, muscle spasm, trigger point and so on) may actually be a sign of something more serious.
For example, I know of a woman who had gradual onset sciatica (nerve pain in the buttock going down the back of the leg). She had massages, chiropractic, acupuncture and physical therapy, but they did not resolve her pain. To make a long story short, she was diagnosed with a brain tumor that was pressing against the motor neurons in her brain that eventually formed the sciatic nerve. Luckily for her, her tumor was operable and her symptoms gradually cleared.
Remember, nerves start from and return to the brain, because that is where the perception of all sensations, not just pain, is processed. If there is a pathology in the brain, it may manifest as symptoms commonly associated with common muscle and nerve conditions.
A second patient I recall complained of a severe headache centered on the right side of her head. The headaches came on rather suddenly, and they were not of the migraine variety. I referred her for an MRI and it turned out that she had a cerebral aneurysm. Although the majority of headaches are not dangerous, it is still important to err on the side of caution if the headache is especially acute, doesn’t respond to medications and if you have a familial history of vascular disease.
Bone pathology/ injury can be a source of pain that may appear muscle/ligament in origin. This can include vertebral compression fractures, bone cysts and bone cancers like osteosarcoma. If you have pain somewhere in your back or believe you have “muscle” pain in an extremity long bone that does not respond at all to physical medicine (chiropractic, physical therapy, massage, stretches, ice/heat, ultrasound etc.) then it is prudent to have diagnostic tests performed to rule out any red flag conditions.
Advanced diagnostic tests for this purpose include:
X-rays, which can show the location, size, and shape of a bone tumor. If x-rays suggest that an abnormal area may be cancer, the doctor is likely to recommend special imaging tests. Even if x-rays suggest that an abnormal area is benign, the doctor may want to do further tests, especially if the patient is experiencing unusual or persistent pain.
A bone scan, which is a test in which a small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it then collects in the bones and is detected by a scanner.
A computed tomography (CT or CAT) scan, which is a series of detailed pictures of areas inside the body, taken from different angles, that are created by a computer linked to an x-ray machine.
A magnetic resonance imaging (MRI) procedure, which uses a powerful magnet linked to a computer to create detailed pictures of areas inside the body without using x-rays.
A positron emission tomography (PET) scan, in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body. ~ National Cancer Institute
If you are seeing a physical medicine provider or alternative practitioner who insists you continue with their treatment despite not experiencing any appreciable results after a few sessions, see your doctor. If you feel like your primary care doctor’s treatment plan isn’t working, don’t be afraid to ask for a referral to a neurologist or orthopedic specialist. Express your concerns, and ask if any of these tests should be ordered to rule out potential, serious conditions.
Chronic pain affects more than 100 million American adults, according to the Institute of Medicine. That’s more than the total affected by heart disease, cancer and diabetes combined. A diagnosis of chronic pain spells trouble, as it implies that it cannot be cured– sort of like a perpetual, terminal illness. While chronic pain does not have the scary reputation of a terminal disease where one is told he has x-months left to live, it is nonetheless devastating to those who suffer from it; relentlessly sapping quality of life for years on end.
The conventional approach to chronic pain treatment is prescribing powerful drugs; i.e. opiod analgesics and non-steroidal anti-inflammatory medications (NSAIDs). But taking these powerful drugs comes at a price. For opiods, it’s addiction, nausea and constipation primarily; for NSAIDs, its gastrointestinal bleeding, increased heart attack risk and kidney damage.
But there is a school of thought that says what is really needed is a transformation in the way chronic pain is viewed.
A program at Mercy Hospital in Portland strives to do that by shifting chronic pain sufferers away from medication and toward behavioral therapy.
The Living Life Well Pain Rehabilitation program is a 12-week, group-based program that helps people learn to cope with chronic pain. Medical director Dr. Stephen Hull says it combines multiple strategies: behavioral therapy, medication management, and physical exercise. The goal at Living Life Well is less about reducing pain and more about helping people resume the activities that are important to them. Participants in the program see an average of about a 40 percent increase in function and a 20 percent improvement in pain.
According to Dr. Hull, when patients make a conscious effort to carry pain with them and move towards the people and things important to them, they actually do better. They have improved function and less pain– and it’s not clear which one enables the other. The pain becomes less of a directing force in their lives.
With pain, the natural tendency, encoded in our genes, is to stop doing the activity that causes it. This is a primitive protective mechanism, and is indeed one of the reasons we need pain. However, with chronic pain the damage has been done, and what people are dealing with is the residual effects of it. In other words, it’s like a perpetual fire alarm that continues to ring, despite the f ire being put out years ago, and all that is left is smoldering embers that are manageable.
So the strategy involves talking to patients and suggesting that they view their pain differently.
Joe Guarna, the program’s psychologist, spends hours in class teaching participants to stop interpreting their pain as a threat; that they can do many of the things they want– basically, make a strong, conscious effort to liberate themselves from their pain. When the patient embraces this and gives it her best effort, most of the time the results are positive. Call it psychosomatic, the power of mind over matter, or other nebulous phenomena of the human body, what matters most is that chronic pain patients get a part of their life back, without the help of powerful drugs that take away other parts of one’s life in exchange for pain relief, a trade more and more people are refusing to take.
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If you experience chronic pain, my suggestion is to talk to your doctor to see how much physical activity you can attempt without adding too much risk to aggravating your condition. You can also consider seeing a personal trainer at your local gym. Personal trainers have more hands-on training and intimate knowledge than most medical providers on the various ranges of motion of joints, muscle function, balance and strength, and they can evaluate your level of physical ability and recommend a customized program for you.
As always, cleansing the body’s tissues and organs is important in the battle against chronic pain. You want to do all that is within your power to give your body a fighting chance to heal and regenerate. Limit your diet to naturally occurring, organic food sources; eliminate overly processed food (which includes all wheat and grain-based food and added sugar and its derivatives); avoid environmental toxins in your environment (there are many!), get adequate rest, keep yourself busy, find a good cause, associate with positive people, and tell yourself you refuse to be hostage to your pain.
The underlying theme of this blog is that by making strategic changes in your daily routine, you can save yourself a lot of pain and dysfunction now and later on in your life. And it’s my desire to share with you some of these simple changes.
Isn’t this a simpler and smarter way to live, rather than being indifferent or oblivious to the fact that your body slowly loses its resiliency as you age, and not taking appropriate, protective measures? If you perform regularly scheduled maintenance to your car, it will last a lot longer than if you do not. The same goes for your body, but the stakes are a lot higher.
One Popular Reason Why People Develop Pain
The problem I see is that most people forget that when you are in your 20s and 30s you can get away with things like prolonged sitting, staying out late and eating unhealthy things like burgers and fries frequently. At that age your human growth hormone is still giving you that fountain of youth energy and your musculoskeletal system, especially your joints, is still in good working order.
However, through your 40s-60s, your job and/or family responsibilities increase and you have less time for yourself, and you think you can take the same abuse that you took in your earlier years. This is where problems start to manifest.
You see, health problems such as degenerative disc disease take years to develop. Take an x-ray or MRI of your neck or low back, and all those nasty osteophytes, thinning discs and crooked spines you see didn’t start yesterday. They started perhaps ten or more years prior.
So, you are either in a situation where you can do lifestyle modifications to reduce the chances of disorders like this from affecting your health and quality of life; or, you already have the disorder, but need to find ways to stop it from progressing and/or reduce its impact on your health and quality of life.
You see, as long as you are alive, your cells have the capacity to regenerate or transform. Depending on the current state of your health and therefore your body’s recuperative capacity, it could take a long time or a relatively shorter time to see results.
For example, if you are overweight; a smoker and drinker and have a negative impression of life, those serve as extra barriers to healing. Get rid of them, and you’ve got a better chance.
A Simple Exercise to Do Daily if You Sit a Lot
Back to those “lifestyle modification” tips that can help you avoid a life of pain.
Here is today’s example, an exercise called Wall Angels. If you find yourself having a slouched upper back, rounded lower back and forward lunging neck, you’ve got to try these. When done regularly, they can help restore and maintain good posture.
Posture affects your spine, joints, muscles, breathing, energy levels and sometimes even mindset. It is critical to have good posture if you expect to achieve optimal health in your life.
Give it a try; all you need is an empty wall with no obstructions:
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I am constantly looking for topics on pain and pain management to address on this blog for the benefit of my readers. When it comes to pain, numbness and other abnormal sensations, it understandably is a cause for concern, especially for cases where the diagnosis is not clear or certain.
and all those nasty osteophytes, thinning discs and crooked spines you see didn’t start yesterday. They started perhaps ten or more years prior.
