Pain treatment options

Benefits: Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to relieve some symptoms caused by arthritis, such as inflammation, swelling, stiffness, and joint pain. However, they do not cure arthritis and will help relieve pain only as long as you continue to take them and they tend to mask pain not treat pain.

Risks: Many side effects are caused by NSAIDs including toxicity to the kidneys, ears, and stomach. They can also interfere with proper healing. They reduce the flow of blood to the kidneys and impair function of the kidneys. The impairment is most likely to occur in patients with preexisting impairment of kidney function or congestive heart failure, and use in these patients should be done cautiously. People who are allergic to other NSAIDs, including aspirin, should not use ibuprofen. Individuals with asthma are more likely to experience allergic reactions to ibuprofen and other NSAIDs. Common anti-inflammatory drugs such as ibuprofen and naproxen may increase the chance of miscarriage if they are taken early in pregnancy.

Benefits: Heat therapy also known as thermotherapy is used to control pain, increase soft tissue extensibility/circulation and increase healing rates. It works opposite of cryotherapy as heat will cause vasodilation causing in an increase in blood flow to an area. Thermotherapy can help in decreasing pain by regulating pain transmission of neurons. Heat can accelerate tissue healing by increasing circulation. This brings in oxygen and nutrients to the specific area being treated and in addition helps remove metabolic waste products. Heat may also help to decrease joint stiffness in superficial joints such as fingers and wrists.
Heat therapy should not be used within the first 72 hours of an acute injury.

Risks: Heat should be used for only 20 minutes and should be checked every 5 minutes to avoid excessive redness, blistering or burning. A lot of people cannot use heat therapy because they are either working or have errands and chores to do so heat can be restrictive to use.

Caution should be used to prevent overheating and use over areas which may not have normal sensitivity such as scars or with diabetes related nerve problems. Do not use over skin rashes or over areas where lotions intended to relieve pain like Biofreeze, Bengay or other are applied. If you have diabetes, avoid hot application to the feet or legs. Also avoid full body heating treatments, such as body wraps. Hot immersion baths and long, hot saunas are not recommended for those with diabetes or multiple sclerosis, women who are pregnant or anyone with abnormally high or low blood pressure. Elderly people and young children may be exhausted by too much heat and should avoid long full-body hot treatments such as immersion baths and saunas.

If you are pregnant or have heart disease, consult a doctor before taking using a sauna.

Benefits: Cold therapy (also known as cryotherapy) is widely used especially in rehabilitation settings. Cold therapy helps to minimize inflammation, edema and pain by constricting blood vessels and slowing down nerve conduction. It can also help in decreasing muscle soreness brought on by new activities or overuse.

After acute injury or trauma the body will get an increase in metabolic reactions and be accompanied by bleeding and/or edema. The application of cold therapy will reduce heat, redness, function loss and pain.

Cancer survivors with permanent lymphedema or patients with lepedema (secondary lymphedema) often benefit greatly from cold compression therapy. (Read more about lymphedema here.) With the benefit of cryotherapy and compression supplied by an Arctic Ease® wrap there is a decrease in the pressure gradient between blood vessels and tissue and discourages further leakage from capillaries this encourages lymphatic drainage.

Cryotherapy slows down the movement of fluid into interstitial tissue thereby decreasing edema and help controlling effects of inflammation. It is also used to control pain as it decreases activity of nerve fibers, which conduct pain sensations to the brain.

Overuse injuries also benefit from cold therapy as they usually cause an inflammatory response on specific tissues from activities. Cold can be applied after an activity to control the inflammatory reactions of the imposed demand.

Traditional Cold therapy products such as frozen ice bags and gel packs should be applied for 10-20 minutes and can be done once an hour.

Unlike traditional cold therapy products such as frozen ice bags or gel packs, Arctic Ease can be applied for hours at a time.

Risks: If someone has hypersensitivity or intolerance to cold, an area with decreased circulation, peripheral vascular disease, or over an area that has regenerating peripheral nerves ice therapy should not be considered.

Cold Hypersensitivity – If you have experienced one of the following, traditional cold therapy treatments (frozen ice bags and gel packs) should be avoided. There are many forms of cold hypersensitivity, which include:

• Raynaud’s disease – an area with decreased circulation, peripheral vascular disease, or over an area that has regenerating peripheral nerves ice therapy should not be considered.
• Cold Erythema – A rash, characterized by redness and itching, caused by exposure to cold. Can cause severe pain and muscular spasms.
• Cold Hemoglobinuria – When red blood cells break down so quickly that some haemoglobin cannot combine with blood proteins.
• Anesthesia – When there is an area of numbness or altered sensitivity, cold therapy should not be used as pain and the degree of cooling cannot be felt by the patient.

The following conditions can be treated with traditional cryotherapy products or Arctic Ease, although extra care may be needed:

• Cardiac Conditions – such as Arthymia, Angina or CHD
• High Blood Pressure – Vasoconstriction could serve to increase blood pressure
• Superficial Nerves – Cold therapy should not be used on an area where nerves pass close to the surface
• Healing Wounds – Cold therapy should not be used over a new wound

Diabetics need to exercise extreme caution when using cold therapy. Additionally, cold therapy should be used with caution in the young, weak or elderly.

When using traditional cold therapy products if you notice your skin becoming numb, blistered, bright red, or blotchy, remove the cold source immediately.

Arctic Ease® should not be used in people who have open wounds and remember that Arctic Ease® is not meant to be as cold as ice. Arctic Ease® products will not have the discomfort of and does not have the risk of tissue or nerve damage of ice or frozen gel packs.

Benefits: Menthol stimulates the muscle’s cool receptors. That is why it produces a cooling effect when applied to the skin. According to ‘wisegeek’ as well as many other sources, it does not in fact change the skin temperature, just the sensation. Apparently, it also blocks pain receptors. Scientific research shows that Menthol (cooling) does not change the skin temperature. Applying it as a topical analgesic alters the pain signals at the spinal cord, and massaging it in ‘stimulates the effects of a counterirritant may increase large diameter afferent nerve input The afferent nerve is a ‘nerve that carries impulses toward the central nervous system

Therefore, menthol is not actually cooling the site at all, it is merely giving you that sensation, and blocking the pain.

Risks: According to MedlinePlus, possible symptoms of overdose from topical analgesic creams containing either menthol or methyl salicylate include changes in breathing, dizziness, loss of vision, ringing in the ears, and nausea and vomiting. Menthol and methyl salicylic acid may produce allergic reactions in sensitive individuals. Use caution when taking Anticoagulants (e.g., warfarin) because the risk of their side effects may be increased by Methyl Salicylate/Menthol Cream. [http://www.drugs.com/cdi/methyl-salicylate-menthol-cream.html]

Seek medical attention for symptoms including rash and severe itching of the skin, any swelling of the throat or mouth or difficulty breathing. Contact a poison control center or seek medical attention if menthol or methyl salicylic acid topical analgesic creams are accidentally taken by mouth.

While not a risk, menthol has a very strong odor.

Benefits: Capsaicin cream or ointment is used on the skin (topical use), it can help relieve some types of pain. Capsaicin works by first stimulating and then decreasing the intensity of pain signals in the body. Although pain may at first increase, it usually decreases after the first use. Capsaicin stimulates the release of a compound believed to be involved in communicating pain between the nerves in the spinal cord and other parts of the body.

Risks: Capsaicin can cause some unpleasant effects, especially for those who are not used to its intense heat. It can also cause skin irritation and can cause the skin to dry out.

An allergic reaction to capsaicin is possible. If you are just beginning to use capsaicin, either as fresh or prepared food or in powder form, start with small amounts. If you use a topical cream, you should first apply it to a small area of skin to test for an allergic reaction.
Do not take capsaicin if you have high blood pressure or are already being treated for high blood pressure.

Benefits: Acetaminophen (Tylenol®) isn’t a NSAID, but it sometimes does reduce pain and fever. Unlike NSAIDs, however, this medication does not reduce inflammation.

Risks: Acetaminophen is the leading cause of liver failure in the U.S., sending 56,000 people to the emergency room annually. In addition, it does not always work that well on pain.