If you've ever rubbed a topical pain reliever—a cream, gel or other The Food and Drug Administration (FDA) is warning that some relievers as Icy Hot, Bengay, Capzasin, Flexall, and Mentholatum. Alimentos y Bebidas Cosméticos Dispositivos Médicos Dispositivos que Emiten Radiación Fraude en. Brand Name: Absorbine Jr., Analgesic Balm Greaseless, Arthricare Cream, BENGAY Ultra, When using methyl salicylate topical cream, gel, lotion, oil, ointment, Methyl salicylate can cause a cold or burning sensation wherever it is Since methyl salicylate topical is used as needed, it does not have a. BENGAY Ultra (for the skin) is used for temporary relief of muscle or When using BENGAY Ultra cream, gel, lotion, oil, ointment, or spray: Methyl salicylate can cause a cold or burning sensation wherever it is applied. Since BENGAY Ultra is used as needed, it does not have a daily dosing schedule.
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Also, using too much can be toxic. In the United States, the Food and Drug Administration has approved several topical products Voltaren, Solaraze, 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.
A single copy of these materials may be reprinted for noncommercial personal use only. This content does not have an English version. This content does not have an Arabic version. Treatments absorbed through your skin. Free E-newsletter Subscribe to Housecall Our general interest e-newsletter keeps you up to date on a wide variety of health topics. Treatments absorbed through your skin Learn about the various types of topical pain medications available for pain relief. By Mayo Clinic Staff.
References Managing your pain. Accessed May 11, Altman RD, et al. Topical therapies for osteoarthritis. Voltaren gel offers rub-on relief. Evolving guidelines in the use of topical nonsteroidal anti-inflammatory drugs in the treatment of osteoarthritis. Mayo Clinic on Arthritis Book: Mayo Clinic Guide to Pain Relief.
Elbow Replacement Elbow replacement surgery Glucosamine: Does it affect blood sugar? Does it protect cartilage in osteoarthritis? Golf and Wrist Pain Heel spurs: Methyl salicylate may contribute to effects on blood flow. For example, it has been reported that an analgesic balm containing methyl salicylate and capsaicin applied to the forearm skin attenuated muscle-contraction—induced increases in blood pressure.
Although all 3 types of products are sold over the counter and used commonly, a head-to-head comparison of the effects of the 3 types of products on skin and muscle temperature and blood flow has not been made.
The hypothesis to be tested was that continuous low-level heat ThermaCare would provide faster changes in deep tissue temperature than the other 2 products.
The purpose of this investigation was to assess the physiologic effects of 3 popular OTC topical analgesic products, ThermaCare HeatWraps, Icy Hot Patches, and Icy Hot Cream, for their ability to increase temperature and blood flow in both skin and muscle. Subjects were recruited by flyer to students, staff, and faculty at Loma Linda University or Azusa Pacific University in spring of All protocols and procedures were approved by the Institutional Review Boards of Loma Linda University or Azusa Pacific University, and all participants provided written informed consent prior to any study procedures.
This study was supported by an executed investigator-initiated agreement with Wyeth Pharmaceuticals, which was acquired by Pfizer Pharmaceuticals in October Skin over the belly of the quadriceps muscle was then sterilized, and skin and muscle probes were placed as detailed below. All probes were placed 1 cm apart on the skin surface. A single skin temperature sensor was used to calibrate the emissivity of the camera such that temperatures measured with the camera were validated.
This device, which consists of a gauge thermocouple with a time constant of 0. Position and depth were confirmed by ultrasonography, and the needle was removed, leaving the thermocouple catheter in place for the duration of the 2-hour study period.
Its output was transduced by an IsoThermix digital thermometer system Columbus Instruments. The device is accurate to 0. Tympanic temperature was measured using an infrared thermometer Braun Thermoscan Type ; Braun GmbH, Kronberg, Germany as an assessment of central core temperature. Skin blood flow was recorded at 6 sites around the belly of the quadriceps muscle at each time point using an infrared laser Doppler flowmeter, and an average of the 6 results was calculated.
The unit was warmed for 30 minutes before flow measurements, and the flow probe was calibrated prior to and at the end of each series of experiments. A fiber-optic plastic catheter was delivered to deep muscle tissue through the barrel of a gauge needle under sterile conditions, as described for the thermocouple probe. An infrared laser probe emitting a very low level beam through the fiber-optic catheter was then used to sample blood flow in a 1-mm 2 area.
The amplifier and digital converter described above for skin blood flow also were used in the muscle blood flow measurements. Following placement of the thermocouples and blood flow probes, 1 of 3 OTC products designed for relief of muscle pain was placed or applied to the skin over the belly of the quadriceps muscle: ThermaCare HeatWraps produce a chemical dry heat resulting from an iron oxidation reaction.
We applied the wraps over the quadriceps muscle so that the center of the wrap was immediately over both needle insertion points. Because Icy Hot products are contraindicated for application over a wound, the catheter insertion sites were sealed with collodion, and a hole 1 cm in diameter was cut in the center of the Patch and placed around the catheter insertion points. No Cream was applied within 0. Each participant received all 3 treatments in a random sequence based on a statistical table.
Treatments were administered open label, 1 each on 3 separate days separated by a period of 1 day between treatments. Temperature and blood flow were recorded continuously for muscle tissue and analyzed at minute intervals during the first 2 hours after application.
Skin measurements were made every 30 minutes to allow for momentary removal of the heat wraps; data for the intervening minute intervals were interpolated by averaging the data from the prior and succeeding times. Thermal images were made at the time of product application and at minute intervals for 2 hours thereafter. Means and standard deviations SDs were calculated for skin and muscle temperature and blood flow at each time point.
Fifteen healthy volunteers, 12 men and 3 women, were enrolled in the study and completed assessments with all 3 treatments. The mean SD age of subjects was Mean SD skin temperature decreased to Mean SD skin temperature was This increase over baseline of 7.
Yellow indicates cooler temperature; red and blue indicate hotter temperature. Muscle temperature was a mean SD of Thus, 2 hours after application, ThermaCare HeatWraps increased muscle temperature by a mean of 2. Core temperature was unchanged under any of the 3 topical treatment conditions. Mean core temperature at baseline was After 2 hours, mean core temperature was Differences in skin blood flow at baseline were observed in the 3 treatment groups, but these differences were not statistically significant.
Icy Hot Patches produced a rapid decrease in mean SD blood flow in skin from With ThermaCare HeatWrap application, blood flow increased steadily during the first hour of application, from a mean SD of This represented a statistically significant increase in skin blood flow of Differences in muscle blood flow were observed at baseline among the 3 treatment arms. These differences may have been attributable to differences in the area sampled by the probe eg, middle of the muscle vs near the fascia.
Muscle blood flow mean SD was The resulting net increase in mean muscle blood flow from baseline to 2 hours was 7. Mean SD muscle blood flow was After an initial lag of about 30 minutes, ThermaCare HeatWraps produced a steady increase in muscle blood flow, increasing it nearly 1. Mean SD blood flow in the quadriceps was The present investigation was a longitudinal study of the effect of heat and menthol on tissue temperature and blood flow. As such, each subject was their own control and the pretest to posttest difference required no control group.
To our knowledge, this is the first study directly comparing the effects of heat wraps vs menthol-containing topical analgesics on skin and muscle temperature and blood flow. As expected, application of ThermaCare HeatWrap quickly warmed the skin by These results are consistent with those of other studies, which have shown that heat, even at low levels, results in vasodilation and increased blood flow.
Initially, heat prompts rapid vasodilation by promoting release of neurotransmitters eg, calcitonin gene-related peptide and substance P from endothelial cells. Edwards et al 36 observed Q 10 values averaging 3. Increased blood flow has been shown to promote tissue healing by increasing oxygen delivery, removing metabolites, and enhancing metabolism in damaged muscle tissue.
Analgesic and vascular effects of heat are, at least in part, mediated through activation of TRP membrane channels. There are 28 different mammalian TRP membrane channels, 37 which can be activated by temperature, pain, tissue osmolarity, oxidative stress, lipids, intracellular calcium elevation, cooling agents eg, menthol, icilin , and other factors.
TRPV1 receptors play a role in nociceptive pain processing. Our findings of increased temperature and blood flow suggest that ThermaCare HeatWraps have the potential to provide both analgesia and improved tissue healing. This is consistent with results from one of our previous studies in which application of low-level heat wraps following exercise enhanced muscle healing as evidenced by reductions in fascial edema measured on ultrasonography , white cell counts, and heat shock protein 27 a biomarker for muscle damage.
In contrast to our findings with ThermaCare HeatWraps, the 2 menthol-containing products Icy Hot Patches and Cream brought about a modest cooling effect in skin and muscle tissue. We attribute the difference in the effect of Icy Hot Cream on blood flow in skin vs muscle to the fact that alcohol evaporation on skin may lead to a cooling effect, whereas the menthol penetrates to muscle, where it may have a direct effect on blood flow. Thus, the analgesia provided by menthol-containing products is less likely to be accompanied by tissue healing compared with the use of nonmenthol heat products.
This should be taken into consideration, along with the potential for chemical burns associated with menthol-containing products, 50 when recommending OTC therapies to patients with DOMS or other forms of muscle soreness. It is noteworthy that skin and muscle cooling was seen even with the Icy Hot Cream, which also contains methyl salicylate. Aspirin directly stimulates endothelial NO synthase to form NO, 51 which in turn induces vasodilation, increasing blood flow.
It is also noteworthy that, for both skin and muscle, the blood flow—temperature ratio showed the greatest deviations over time with the Icy Hot Cream. Menthol is a topical analgesic of the counterirritant class. Unfortunately, this study did not examine blood flow and muscle temperature. These findings suggest that, whereas all of these products may have an analgesic effect, heat wraps are likely the superior choice to facilitate repair of damaged muscle tissue in DOMS and similar conditions.
Limitations of our study include its small sample size and nonrandomized open-label design. However, all participants received all 3 treatments, and objective measures were used to assess temperature and blood flow, limiting their subjectiveness to bias. This study was conducted in a population of pain-free individuals, so it was not possible to compare analgesic effects or evaluate any correlation between analgesia and either temperature or blood flow.
Assessments were limited to the first 2 hours after product application; however, ThermaCare HeatWraps and Icy Hot Patches are recommended for up to 8 hours of use.
Replication in a larger population of patients with DOMS would be informative, as would assessment of biomarkers of muscle damage during and after treatment. In this study of 15 healthy adults, ThermaCare HeatWraps increased skin and intramuscular temperature, and local blood flow.
In contrast, topical analgesics containing menthol with or without a prostaglandin inhibitor had a cooling effect on skin and muscle temperature. Medical writing support was provided by Lauren Cerruto and John H. Dr Michael Laymon's previous institution, Loma Linda University, received grant support in connection with this study. Dr Lee Berk has nothing to disclose. National Center for Biotechnology Information , U. Journal List J Chiropr Med v. Published online Feb Author information Article notes Copyright and License information Disclaimer.
Abstract Objectives The purpose of this study was to compare the effects of over-the-counter treatments—ThermaCare HeatWraps chemical reaction to produce heat above the skin , Icy Hot Patch, and Icy Hot Cream topically applied menthol —on skin and deep tissue temperature. Methods This was a longitudinal crossover study. Results After 2 hours, mean temperature decreased by 2.
Methyl salicylate topical
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