World of Hurt: Latest offerings for pain relief
Monday January 23, 2012
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A home exercise program is a vital part of the treatment plan for many physical therapists' patients, but a common obstacle to compliance is the pain from their injuries or conditions.
Tom Watson, PT, DPT, DAAPM, of Rebound Physical Therapy in Bend, Ore., said he uses topical interventions for patients at home. "I recommend them to help them to relieve some of their pain when they're not in the clinic and they want to take less medication," he said. Watson, who primarily treats patients who have chronic pain from difficult intractable headaches, neuropathic pains, fibromyalgia, chronic low back pain or peripheral neuropathy, said the topicals allow patients to be more active. "It allows them to get around better and be more functional, so they can do their activities of daily living and feel better in the process," Watson said.
Musculoskeletal pain
For musculoskeletal pain, Watson said he often recommends over-the-counter topical analgesics which include Biofreeze, Icy Hot and Flexall 454. These products are basically mild counterirritants that alleviate some of the pain, he said.
"The main reason to reduce pain is to facilitate movement and exercise because that's really what heals the patient," said Phil Page, PT, ATC, CSCS, FACSM, director of clinical education and research for Performance Health Inc., which produces the menthol-based topical analgesic Biofreeze. "And if they have pain, one of the problems is they won't do their exercises, but another problem is they will do them incorrectly and perform compensation substitutions."
Page said one way to describe how Biofreeze relieves pain is the gate-control mechanism, in which certain nerve fibers are stimulated so they override the pain sensation other nerve fibers are sending to the spinal cord. "Basically, it replaces the sensation of pain with another sensation," Page said. He cites emerging studies suggesting menthol also has the ability to reduce pain by stimulating the specific temperature receptors in the skin, which leads to a more central reduction in pain.
A study by a group of researchers in the University of Louisville (Ky.) Department of Exercise Physiology published in the August 2011 Journal of Sports Rehabilitation compared the results of ice and 3.5% menthol gel on blood flow and strength. They found menthol reduced the blood flow by 42% five minutes after it was applied, but no reduction was noted 10, 15 or 20 minutes after application. Ice took longer to reduce blood flow, with a 48% decrease after 20 minutes. The researchers noted while ice seemed to inhibit muscle strength, the menthol gel resulted in about an 8% increase in muscle strength.
Biofreeze comes in a gel, spray, roll-on or wipes. In June 2011, Performance Health added Biofreeze Pain Relieving Singles, stamp-sized pouches that fit in a purse or pocket and allow patients to apply the product without getting it on their hands.
Neuropathic pain
For patients who are dealing with neuropathic pain, Watson suggests a cream such as Zostrix that contains purified capsaicin, derived from the cayenne pepper. "Cayenne pepper goes through the skin and absorbs substance P, which is a primary cause of pain," Watson said. "We don't know what causes neuropathies, but substance P seems to interfere with it."
He also suggests patients use homeopathic products such as Speed Gel, Topricin and Neuragen PN for neuropathic pains. The homeopathic creams and gels don't cause a burning or cooling sensation on the skin, like capsaicin or menthol would, Watson said.
Speed Gel has a transdermal delivery system, which differs from a counterirritant, according to Gary Walters, PT, vice president of corporate development for Gensco Laboratories, which produces Speed Gel. "The theory behind a transdermal is it takes an ingredient and delivers it through the skin to actually effect a change," he said. "[It] allows for the active ingredients to be transported from topical, through the skin, to the site of involvement."
Walters said Speed Gel has no odor, is all natural and works well on many patient populations because it isn't taken into the bloodstream. It contains multiple homeopathic active ingredients that block pain, prevent bruising and fight inflammation. Walters said Speed Gel shows positive results on sprains, strains and contusions. He said the company is researching the use of Speed Gel on osteoarthritis of the hand, ACL tears and bruising, with the goal of showing reduced use of narcotics.
Another homeopathic option is Topricin, made by Topical BioMedics Inc. It has no odor, cooling or heating sensations and has a patent for the treatment of pain associated with fibromyalgia. "Because it's natural the body recognizes it and absorbs it, reducing the inflammation, restoring the blood flow and the oxygen to that area so the body ... can heal itself," said Loraine Greene, customer relations director with Topical BioMedics. Like Speed Gel, Topricin does not go into the bloodstream.
Physical interventions
Watson said he rarely uses topical products in the clinic. "Most of the time in the clinic I'm doing things that will help get the patient better such as manual therapy, exercise, cold laser and microcurrent stimulation that actually helps to heal tissues," he said.
According to Watson, heat and cold are high-intensity afferents, so the area of skin and underlying tissue potentially will be much less tender, which makes manual therapy work less painful. He said heat and cold work within 3 to 5 minutes locally and can relieve pain for anywhere from 15 minutes to an hour.
A new product from Innovative Medical Equipment in Cleveland aims to make it easier for PTs and patients to get the benefits of hot and cold modalities. ThermaZone, a thermoelectric device designed for PTs, comes out this month, according to Margie Rowe, director of marketing for the company. Thermoelectric equipment often is seen only in hospitals because it can be pricey, she said. "ThermaZone is much more affordable and portable for PTs who are working remotely or in home care." The device costs $349, and the pads are $119 each.
She said PTs could use the device in the clinic, but also could prescribe one for a patient or set up a program where the patient rents the device and purchases his or her own pad. •
Bonnie Benton is a staff writer.
Tom Watson, PT, DPT, DAAPM, of Rebound Physical Therapy in Bend, Ore., said he uses topical interventions for patients at home. "I recommend them to help them to relieve some of their pain when they're not in the clinic and they want to take less medication," he said. Watson, who primarily treats patients who have chronic pain from difficult intractable headaches, neuropathic pains, fibromyalgia, chronic low back pain or peripheral neuropathy, said the topicals allow patients to be more active. "It allows them to get around better and be more functional, so they can do their activities of daily living and feel better in the process," Watson said.
Musculoskeletal pain
For musculoskeletal pain, Watson said he often recommends over-the-counter topical analgesics which include Biofreeze, Icy Hot and Flexall 454. These products are basically mild counterirritants that alleviate some of the pain, he said.
"The main reason to reduce pain is to facilitate movement and exercise because that's really what heals the patient," said Phil Page, PT, ATC, CSCS, FACSM, director of clinical education and research for Performance Health Inc., which produces the menthol-based topical analgesic Biofreeze. "And if they have pain, one of the problems is they won't do their exercises, but another problem is they will do them incorrectly and perform compensation substitutions."
Page said one way to describe how Biofreeze relieves pain is the gate-control mechanism, in which certain nerve fibers are stimulated so they override the pain sensation other nerve fibers are sending to the spinal cord. "Basically, it replaces the sensation of pain with another sensation," Page said. He cites emerging studies suggesting menthol also has the ability to reduce pain by stimulating the specific temperature receptors in the skin, which leads to a more central reduction in pain.
A study by a group of researchers in the University of Louisville (Ky.) Department of Exercise Physiology published in the August 2011 Journal of Sports Rehabilitation compared the results of ice and 3.5% menthol gel on blood flow and strength. They found menthol reduced the blood flow by 42% five minutes after it was applied, but no reduction was noted 10, 15 or 20 minutes after application. Ice took longer to reduce blood flow, with a 48% decrease after 20 minutes. The researchers noted while ice seemed to inhibit muscle strength, the menthol gel resulted in about an 8% increase in muscle strength.
Biofreeze comes in a gel, spray, roll-on or wipes. In June 2011, Performance Health added Biofreeze Pain Relieving Singles, stamp-sized pouches that fit in a purse or pocket and allow patients to apply the product without getting it on their hands.
Neuropathic pain
For patients who are dealing with neuropathic pain, Watson suggests a cream such as Zostrix that contains purified capsaicin, derived from the cayenne pepper. "Cayenne pepper goes through the skin and absorbs substance P, which is a primary cause of pain," Watson said. "We don't know what causes neuropathies, but substance P seems to interfere with it."
He also suggests patients use homeopathic products such as Speed Gel, Topricin and Neuragen PN for neuropathic pains. The homeopathic creams and gels don't cause a burning or cooling sensation on the skin, like capsaicin or menthol would, Watson said.
Speed Gel has a transdermal delivery system, which differs from a counterirritant, according to Gary Walters, PT, vice president of corporate development for Gensco Laboratories, which produces Speed Gel. "The theory behind a transdermal is it takes an ingredient and delivers it through the skin to actually effect a change," he said. "[It] allows for the active ingredients to be transported from topical, through the skin, to the site of involvement."
Walters said Speed Gel has no odor, is all natural and works well on many patient populations because it isn't taken into the bloodstream. It contains multiple homeopathic active ingredients that block pain, prevent bruising and fight inflammation. Walters said Speed Gel shows positive results on sprains, strains and contusions. He said the company is researching the use of Speed Gel on osteoarthritis of the hand, ACL tears and bruising, with the goal of showing reduced use of narcotics.
Another homeopathic option is Topricin, made by Topical BioMedics Inc. It has no odor, cooling or heating sensations and has a patent for the treatment of pain associated with fibromyalgia. "Because it's natural the body recognizes it and absorbs it, reducing the inflammation, restoring the blood flow and the oxygen to that area so the body ... can heal itself," said Loraine Greene, customer relations director with Topical BioMedics. Like Speed Gel, Topricin does not go into the bloodstream.
Physical interventions
Watson said he rarely uses topical products in the clinic. "Most of the time in the clinic I'm doing things that will help get the patient better such as manual therapy, exercise, cold laser and microcurrent stimulation that actually helps to heal tissues," he said.
According to Watson, heat and cold are high-intensity afferents, so the area of skin and underlying tissue potentially will be much less tender, which makes manual therapy work less painful. He said heat and cold work within 3 to 5 minutes locally and can relieve pain for anywhere from 15 minutes to an hour.
A new product from Innovative Medical Equipment in Cleveland aims to make it easier for PTs and patients to get the benefits of hot and cold modalities. ThermaZone, a thermoelectric device designed for PTs, comes out this month, according to Margie Rowe, director of marketing for the company. Thermoelectric equipment often is seen only in hospitals because it can be pricey, she said. "ThermaZone is much more affordable and portable for PTs who are working remotely or in home care." The device costs $349, and the pads are $119 each.
She said PTs could use the device in the clinic, but also could prescribe one for a patient or set up a program where the patient rents the device and purchases his or her own pad. •
Bonnie Benton is a staff writer.
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Monday January 23, 2012