About Joshua Cappuccilli Expertise I can answer most questions involving medication use, side effects, adverse effects, interactions and how drugs relate to specific disease states. Noone can answer all questions; I will respond as such if I cannot provide an answer. I will provide resources / references for the information that I use to formulate the answer given.
Experience I am a PharmD with my degree from the University of FLorida - currently I am preparing to take the state boards in Florida.
Organizations California Phamacist Association
American Pharmacy Assocaition
Education/Credentials BA University of South Florida
PharmD University of Florida
Expert: Joshua Cappuccilli Date: 3/6/2008 Subject: hot rubs
Question QUESTION: First, I'd like to thank you again for the extremely helpful answer you gave to a question I asked you two months ago concerning an issue with NSAIDs and the digestive tract.
Now for the present question. For some problem I have with achiness in the muscles, I use a muscle rub that's like Ben-Gay (it smells like wintergreen, etc.). I have heard also of rubs that contain capsaicin. My question is this: are these two different hot-feeling chemicals essentially equivalent to one another, such that using one is functionally the same as using the other? or do the wintergreen kind of rub and the capsaicin kind of rub affect the body in ways different enough that one can be more efficacious than the other in different circumstances? If the latter, for what purposes would the capsaicin rub be better?
Thank you.
ANSWER: Rubs like Ben-Gay and others that primarily use menthol (or similar ingredients) are "counter irritants" - they are presumed to work in two ways 1) They produce a surface irritant (slight) manifested as heat or cold that distracts the nerve body responses from the chronic pain and transmits the new sensation in its place. 2) by irritating the area they may cause a mild inflamatory response locally - bringing the body's normal pain moderating compounds along to decrease pain. The data that exists in these types of creams is mixed (mainly because ...*****warning opinion follows that cannot be substantiated******..... they are not prescription - so they are not supported by research and development $$ that other medications would be). You (I) could build a case for or against topicals with plenty of literature to support either view - this is a 'must try' thing.
This is different from Capsacian creams. These creams work by over exposing the nerve response to pain - capsacian creams are not pleasant (usually) to put on and produce a burning sensation for days (or weeks) when applied. They take up to 4 weeks to work. The repeated exposure to negative stimulation over the course of days or weeks diminishes the nerve response locally and reduces the transmission of the signal for the chronic pain. These have reasonable clinical data to support use. They are often not used correctly, expected to work faster than they do or stopped because of the initial discomfort.
Hope that helps!
Be Well.
Joshua
---------- FOLLOW-UP ----------
QUESTION: Thanks again for your thoughtful answers. A follow-up:
Do I understand correctly that these rubs work solely on reducing the message of pain, by working on the nerves? In other words, is there no healing involved? And would I be correct in thinking that things like massage and a hot whirlpool would be more therapeutic, i.e. in loosening up the tightness and bringing additional blood to the tissues?
Answer Yes - there is no 'healing' involved. The counter irritants may work secondarily like you are describing - by irritating the area it also can increase blood flow and natural endogenous anti-inflammatory compounds in the area that may also decrease pain but this is (probably) transient.
