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Topical Analgesics
ten for today

By Rebecca Jones

Originally published in Massage Bodywork magazine, Jan/Feb 2010. Associated Bodywork and Massage Professionals. All rights reserved.

Nothing beats a massage for working the kinks out of tired, aching muscles. But sometimes, something more than the therapeutic touch of a hand is needed. Topical pain relievers--whether in the form of creams, gels, lotions, or oils--can be useful tools in a massage therapist's kit.

But before slathering any analgesic substance on a client, it's good to know the basics about their proper use and handling.


1. Some are cool; some are warm
The feeling of warmth or coolness is produced by ingredients that slightly irritate the skin. Menthol and camphor are two commonly used irritants that produce a cool feeling on the skin and help control swelling and inflammation. Capsaicin, which comes from pepper plants, is a commonly used ingredient that can cause a warm or burning sensation. Warm therapies tend to loosen up tight joints and muscles, improve circulation, and suppress nerve endings that transfer pain signals to the brain.

"Cool therapy, or cryotherapy, is used more for injuries that just occurred, like where you would use a bag of ice to help with swelling and inflammation," says Jeff Basket, marketing program manager for Sombra Professional Therapy Products of Albuquerque, New Mexico, makers of Original Warm Therapy and Cool Therapy, both pain-relieving gels. "What's nice about cool therapy is that it's a way to provide a cooling element without having to deal with an ice pack. Plus, it's soothing."

Warm therapy, on the other hand, is more often used for chronic pain, including arthritis, bursitis, or fibromyalgia.


2. Know when, where, and how to use these products
"They're very beneficial, but you want to use them in moderation," says Jean Shea, founder of Biotone, a San Diego-based company that markets the menthol-based lotion Polar Lotion. "You certainly wouldn't use them for an all-over body massage. You should use them only in those areas where the client is complaining of pain."
Shea notes that pain gels and lotions tend to work best on joints that are close to the surface and are less effective when pain is deep inside the body.

Herbalist Laurie Nitchman, founder of Nature's Light of Bennett, Colorado, makers of PRO Pain Relief Ointment, advises therapists to apply the pain gels and lotions just as they would any sort of massage oil. "The best thing for therapists is to pump some onto their hands to warm it up, then start rubbing it in a circular motion," she says.

A note of caution: avoid using a circular motion with analgesics that come in roll-on form. Most are designed to be applied in a straight line, so they don't rotate properly when applied in a circle.

Whatever you do, don't forget to thoroughly wash your hands afterward. Water alone typically won't remove all of a pain gel.


3. Before or after the massage?
That depends, say experts. If a client comes in complaining of acute pain in a certain spot, massaging that area may well cause extreme discomfort. "We recommend you put the topical on that area, then give it a few minutes before massaging that area," suggests Bob Poirier, vice president of Performance Health Inc., of Akron, Ohio, makers of the Biofreeze pain-relieving product line. "In most cases, you can massage that area effectively within five minutes."

Alternatively, a deep-tissue massage may actually create some inflammation and soreness in certain areas, so applying a cool therapy pain reliever immediately after the massage can help limit the resulting discomfort. If you're using warm therapy, however, oil can keep the capsaicin from penetrating the skin. So post-massage application would be less effective.


4. Be wary of topical analgesics containing ibuprofen
In August 2009, the Food and Drug Administration (FDA) issued warnings to eight companies for illegally marketing such compounds. Ibuprofen is widely available in tablet form, but the FDA has not approved the sale of any ointments containing the drug. Some companies promoted the ibuprofen topicals as superior to oral ibuprofen because they didn't carry the same risk of side effects, such as stomach ulcers. The FDA disputed that claim.

"Some people just get a gel and throw ingredients in there and hope that it works," complained Gurukirn Khalsa, co-owner of Soothing Touch, of Santa Fe, New Mexico, makers of Herbal Heat Gel and Herbal Ice Gel. "The ibuprofen products are a good example of that. Even though the concept seems sound, before people make claims, it's got to have some science behind it."


5. Remember that even "all-natural" products should be handled with care
As with any foreign substance, keep these pain relievers away from clients' eyes, open wounds, or damaged skin. Be sure to ask new clients about known allergies before putting anything on their skin. And take special precautions with pregnant women.

"It's always a good idea to go over a product with a new client and find out if there are any allergies in play, any ingredient sensitivities," Khalsa says.

Likewise, be wary of wrapping a body part in order to enhance the pain reliever's power. "You don't want to wrap a warm therapy," Baskett advises. "You could really irritate the skin that way."


6. Topical pain relievers must be stored correctly
"Sunlight is not a good thing," Khalsa says. "Keep it in a cool, dark place if you can, and the less light the better. It's best when used at 60-72 degrees. And if it sits in a scorching car, it will get thin and start to break down."

Shelf life typically ranges from two to three years, but much depends on usage, according to Poirier. "If you've used half and opened the container many times, because of the evaporation of some of the liquid, it could be less potent. But if you've hardly opened it at all, it could still be quite potent even after three years."


7. Consider getting a pump applicator
Squeezing out a little bit from a tube at home is one thing. But a professional who will be using a substance repeatedly on clients really should go the pump route, experts say. "Whenever you dip your hand into something, you can introduce impurities," Poirier says.


8. Alternatives to gels, lotions, and creams
Soothing Touch's Narayan Oil isn't a gel or a lotion or a cream. It has the viscosity of an oil, and so lends itself well to massage therapy. The product is a blend of clove, eucalyptus, and peppermint essential oils in a sesame oil base. "The formula was given to us by a yogi in the 1970s, and we've been mixing it up, blending it, and selling it ever since," Khalsa says. "It's one of those formulas that's been passed around and passed around. We started out just using it on ourselves, but it's a great blend for sore muscles."
Ayurvedic practitioners have been using forms of Narayan oil as a pain reliever for hundreds of years, so for those who prefer something a little more exotic, this is an option.

One example of a no-mess analgesic product is Set-N-Me-Free Aloe Company's aloe heat balm stick. The product is more of a solid that's rubbed over the skin. "You don't have to get your fingers messy," says Jan Heinrich, managing director of the Portland, Oregon, company. She says clients often keep sticks in the car to combat stiff necks while on long drives.


9. Don't overlook analgesic products as a source of incomeThe products you, as a health-care professional have access to, tend to be stronger than what your clients can buy over the counter in retail stores. And you can use that to your advantage by making your products available to clients.

"I think it's a therapist's obligation to provide to their clients the products they believe in and use themselves," says Performance Health's Poirier. "I expect my massage therapist to tell me what I should be using, and to sell it to me, not to send me off to a retail store to buy a brand that may or may not work."

Once you've identified a product you can endorse, ask the manufacturer to work with you. Many will provide you with free samples you can pass along to clients, along with brochures that carry your name and contact information. They may also provide you free samples of products you haven't tried, in order to allow you to assess for yourself its efficacy. Take advantage of this.

Others will put their product in private label packages, which you can use as a marketing tool for your practice. "We understand small businesses," Nitchman says. "We know many massage therapists don't have a lot of money to spend on private labeling, so we'll work with them. We can help them look big without having to spend big money. We're willing to help them because it helps us too."


10. Go with what you know
Don't gamble on untried products just because the price is right, the packaging is pretty, or the advertising sounds convincing. Read the ingredients and weigh what you know about the healing properties of various substances. Go online to check out databases. Develop a relationship with companies whose products have proven worthwhile in the past. And before using anything on a client, try it out on yourself and on friends first.

"Find something that works for you," Khalsa advises. "The real way to look for products you can use on your clients is to test them yourself."

Rebecca Jones is a Denver-based freelance writer. Contact her at killarneyrose@comcast.net.




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