Ask the Doctors

Dear Doctor: I play in a weekend softball league, and my shoulder aches for a couple of days after the game. Aspirin hurts my stomach, so I wonder whether using a pain medication in a cream or an ointment might help?

Dear Reader: Thanks to effective over-the-counter drugs, banishing minor aches or pains is as easy as a trip to your medicine cabinet. These pain relievers, which are also used to reduce fever, fall into two main categories. One is acetaminophen, sold under the brand name Tylenol. The others are nonsteroidal anti-inflammatory drugs, or NSAIDs. Aspirin, ibuprofen and naproxen (sold under the brand name Aleve) are all NSAIDs.

As you have found, stomach upset can be a side effect of NSAIDs like aspirin. For people who prefer not to take ibuprofen or NSAIDs in pill form, topical pain relievers, which are applied directly to the skin, offer an alternative. The idea is that the medication, when placed on or near the point of pain, will be absorbed into the body, bypassing the stomach, and offer targeted relief.

A visit to the drugstore for a topical pain reliever can be confusing. Not only do you have your choice of creams, gels, foams, patches, sprays and (we're almost done) roll-ons, the products themselves fall into several distinct categories. Once you understand what they contain and how they work, you can decide what's right for you.

-- Topical NSAIDs: Yes, we're talking about aspirin, ibuprofen or naproxen again. However, studies show that blood levels of NSAIDs that are delivered through the skin are quite low, so potential for stomach upset is greatly reduced. What's important here is to follow the dosage recommendations. Don't use too much or reapply too often. And never use multiple NSAID products at once. Talk to your doctor about which ones to use, because they exist in both prescription and over-the-counter forms.

-- Capsaicin: This is the compound in chili peppers that gives them their kick. Topical products with capsaicin work by essentially desensitizing your body's pain response. However, some people find the burning sensation to be so intense that they are replacing one kind of discomfort with another.

-- Menthol: Like capsaicin, menthol is a counterirritant that creates a new, cooling sensation powerful enough to distract from the pain.

-- Methyl salicylate: Also known as oil of wintergreen, this is another counterirritant. It first makes the skin feel cool, and then feel warm. It's similar to aspirin, so be sure to read the label for counter-indications.

Finding a product you like may take some trial and error. When you do:

-- Remember that topical pain relievers are meant for pain that is mild to moderate.

-- They should be used for no longer than seven days, unless your doctor says otherwise.

-- Wash your hands immediately after applying the product.

-- Never use on an open wound or damaged skin.

-- Do not wrap or bandage the affected area until you're sure the product has been fully absorbed, as warmth and pressure may cause a higher level of absorption.

-- For that same reason, you should never use a heating pad with these products.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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