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“НАШЕ ЖИТТЯ”, ЛИСТОПАД 2019 WWW. UNWLA .ORG 33 SHOULD YOU RUB IT IN? by Ihor Magun, MD, FACP Topical applications of medications have become quite popular. Pain relief, in the form of a cream or ointment, applied to an area of disco mfort sounds like a great idea. After all, why reach for an oral agent ( which, with chronic use , can lead to gastro- intestinal irritation and kidney damage) if local ap- plication may be a better choice? This month’s col- umn provides a brief overview of topic a l medica- tions, and begins with an ex planation of what they are and what they do. To begin with, a topical medication pro- vides the intended benefit locally and directly un- der the application site. Because it is not in gested, t here is minimal systemic absorption to the entire body. Unlike with oral medicines, t here is greater tissue concentration of th e medication in the af- fected area , which means the potential for side ef- fect s is greatly reduced. Just for definition clarification — the me di- cations that are the main “go to meds ” for pain re- lief fall under the category of nonsteroidal anti - in- flammatory d rugs (NSAIDs). These include aspi- rin, ibuprofen (Advil, Motrin) or naproxen (Aleve). T opical agents in the over - the - counter category fall into two categories : rubefacients and cap s aicin. Rubefacients focus on localized pain. The way they work is quite un ique. When applied, they pro- voke skin irritation , which ironically relieves pain. This occurs because i rritation of the sensory nerve endings alters or offsets pain in the under lying muscle. The ingredients of rubefacients usually in- clude menthol, which p roduces a cooling sensation (and a recognizable odor) on the skin, which in turn, increases the blood flow and promotes in- creased absorption of the product. The medication is marketed under familiar brand names: Bengay, Absorbine Jr and IcyHot. Capsais in is a nother widely used topical analge- sic and is frequently labeled as a counterirritant. The origin of this analgesic is derived from a hot chili pepper. When ap- plied, this agent causes desensitization of pain fi- bers. There is a rather se- vere burning se nsation upon application. This sen- sation gradually goes away. Capsaisin is available in cream form ( 0.25% cream or 0.75% cream) and is marketed under several brand names (e.g., Capzasin HP, Zostrix and Sloan’s Liniment ) . Prescription topical NSAID medication ha s been available in Europe for years and is now approved for use in the United States. Marketed as Voltaren Gel , it has been found quite helpful , and t he American College of Rheumatology recom- mends this topical NSAID as the first line of treat- ment for hand and knee osteoarthritis. There is some local absorption in the blood stream , but much lower than what is absorbed from oral inges- tion. It should be noted that this medication does not work as well for individuals who have rheuma- toid arthritis . One issue that may cause some peo- ple to view this medication with hesitation or seek other options is cost: Voltaren , which should be applied four times a day, is expensive and is often not covered by insurance. The bottom line is that t here are many pain reliev- ers , both in topical and oral formulations. Tylenol (acetaminophen) was not mentioned above, but it is an excellent antidote to pain and causes no sig- nificant gastrointestinal issues . The only downside here is that it may not be as effective as the NSAIDs or local agents f or some individuals . The other bottom line: Applying medication di- rectly to an affected area sounds intuitive and should be considered as an option. But it is always best to consult with your physician about topical NSAIDs , a nd this applies especially to t hose indi- viduals who chronically need or use such medica- tions i n oral formulations. Your gut will thank you one day. Happy Thanksgiving to all of our readers, authors, photographers, and artists. -- the editors .
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