Off-the-Shelf Solutions

By Frieda Wiley, PharmD, CGP, RPh

Off-the-Shelf Solutions

It’s no secret that spending extra time outdoors engaging in physical activities can do wonders for your health and mood. However, depending on the activity, the additional stress on your joints and muscles caused by increased activity may leave you with aches and pains that can really put a damper on your enjoyment.

Check out these four over the counter pain relievers to help you manage arthritis pain while you’re having fun. In addition, we offer some often-overlooked tips to help determine which treatment is most appropriate for you when you need a quick fix to keep you feeling your best.

In different parts of the world, this daisy lookalike may be called arnica mountain, leopard’s bane, wolf’s bane, or mountain tobacco. A member of the Asteraceae family, arnica—also known by its scientific name, Arnica montana—is a beautiful plant that grows abundantly in alpine environments throughout much of Europe, certain parts of Asia, and randomly throughout the Pacific Northwest of the United States. Herbalists harvest the plant’s roots and flowers for its medicinal properties.

Arnica contains helenalin and dihydrohelenalin, two compounds that counter inflammation and encourage analgesia. You’ll find a variety of products containing arnica as the active ingredient in creams and gels, and in homeopathic tablets that dissolve quickly under the tongue. A little harder to find but just as effective is the concentrated oil extract.

Arnica’s benefits still have not been definitively proven in clinical studies. However, some studies have found that, when taken before surgeries, the plant is more effective than some traditional Western treatments for preventing bruising and controlling swelling. The overall effectiveness of arnica to relieve aches and pains remains a controversial debate among many members of the community in Western medicine, but many people who use arnica have anecdotally reported it to be extremely helpful in easing stiffness and preventing bruising and swelling associated with minor joint injuries, bumps, and sprains.

Arnica is quite commonly combined with other herbs and supplements in creams or lotions for joint pain, aches, and stiffness. Be aware of inaccurate or misleading labeling: Always check the back of label for all ingredients—both active and inactive—in the product before purchasing it. For example, a product currently on the market, Arnica Max, actually lists menthol as its active ingredient while listing arnica as an inactive ingredient.

If you find an arnica plant growing in the wild, do not consume it raw. Reports of toxic effects of raw arnica include internal bleeding, severe stomach upset, difficulty breathing, and racing heartbeat. Avoid arnica if you are allergic to helenalin. People with ragweed, sunflower, or marigold allergies might also be sensitive to arnica. In addition, people with high blood pressure should exercise extreme caution when taken arnica by mouth because it could cause your BP to spike.

The flip side of arnica’s ability to help reduce bruising is that it may hinder or slow the effects of blood thinners. This is more of a concern if you’re taking arnica tablets by mouth as opposed to applying a cream or gel to the skin—the tablets are absorbed into the bloodstream, where blood thinners also have their effect. So, regardless of what form of arnica you’re considering, always ask your doctor or pharmacist about it before taking it, particularly if you’re taking blood thinners like warfarin (Coumadin or Jantoven), enoxaparin (Lovenox), dabigatran (Pradaxa), rivaroxaban (Xarelto), prasugrel (Effient), and clopidogrel (Plavix).

Capsaicin is the chemical that gives peppers their spice, but you can also find it on the shelves of many pharmacies and big box stores in the pain management section. When applied to the skin, capsaicin produces a counterirritant effect: Essentially, it introduces burning, stinging, and itching sensations on the skin surface to counteract underlying discomfort. Capsaicin is very effective for stiff joints caused by arthritis, but more studies are required to demonstrate any benefit in rheumatoid arthritis.

Meanwhile, capsaicin’s uses continue to expand. It has proven beneficial in managing nerve pain caused by diabetes, and recent studies on a nasal formulation of capsaicin indicate that it eases migraines and other severe headaches. In 2009, the U.S. Food and Drug Administration approved a prescription capsaicin patch, Qutenza, to treat nerve pain in patients recovering from shingles. However, over-the-counter products containing capsaicin to soothe stiff joints and achy muscles are still available.

Capzacin HP cream and generic versions contain 0.1% capsaicin, while Zostrix comes in strengths of either 0.025% or 0.075%. Capsaicin can be delivered via a patch, but some people prefer to take capsules containing cayenne pepper or other peppers that contain capsaicin. Beyond its capacity to soothe painful joints, data suggest that capsaicin, when taken orally, may lower blood pressure by encouraging blood vessels to relax and expand.

A few studies suggest that race, ethnicity, and even complexion may influence how well you respond to capsaicin. For example, a 2010 study showed that African Americans are not as sensitive to capsaicin and find it provides less pain relief than do white populations. Hispanics in the study found capsaicin effective for their pain but reported more itching than their Caucasian and African American counterparts. An earlier study showed that South Indians with darker complexions seemed more sensitive to pain than fair-skinned Caucasians when being administered capsaicin injections into the forehead for migraine treatment.

Fortunately, capsaicin doesn’t notably interact with any drugs, but generally, it’s suitable for short-term rather than long-term pain management, which makes it unsuitable for managing pain from arthritis. Effectiveness seems to fade with long-term use, requiring increased application of capsaicin to the affected area for diminishing levels of relief.

Not only that, but long after you have washed the area to which you applied capsaicin, your skin may redden, feel intensely warm, or become sensitive when exposed to hot water. You also may notice a stinging or burning sensation when clothes that you wore when using the product touch your skin, even after they’ve been washed, because the chemical absorbs into the fabric and is very difficult to completely wash out.

Do not apply capsaicin to skin that is already irritated or to an open wound. People with sensitive or thin skin, who have taken oral steroids for a long time, or who are applying other medications and pain relievers to their skin should definitely discuss capsaicin with their doctors or pharmacists before using it.

Menthol, salicylates, and camphor
Menthol is a common active ingredient in products for joint aches and pains, and it is also found in oral care products like mouthwash, cough drops, and breath fresheners. Like capsaicin, menthol works by producing a counterirritant effect, but the sensation for the user feels is different: The skin to which you’ve applied a product containing menthol probably will feel cool or cold instead of hot. Menthol is listed as the lone active ingredient for some name-brand products—Bengay, Aspercreme, Absorbine, Jr., or Tiger Balm—and their generic counterparts.

Many of these same brands and generic products often combine menthol with salicylates to provide even greater relief for more intense pain. Some products—SalonPas DEEP Relieving Gel, Tiger Balm Rub, and Bengay Ultra Strength Cream—all contain menthol and methyl salicylate, along with a less common third ingredient, camphor. Products from the Aspercreme line usually contain trolamine salicylate, while Bengay, Icy Hot, and Salonpas use methyl salicylate. Most brands and generic products offer salicylate-free options for people who are allergic or sensitive to salicylates.

Products containing salicylates are not recommended for children younger than 12 years old. People often find that pain-relieving creams, gels, lotions, ointments, and sprays containing salicylates help them manage their pain while reducing the need for over-the-counter pills or prescription pain relievers. However, it is important to avoid over-applying any pain-relieving product to your skin. Applying salicylates in excessive amounts increases the penetration of the drug into your bloodstream and may cause very serious reactions, including death—young children, older persons, and individuals who may have thin skin, such as patients who may have been taking corticosteroids for a long time, are particularly at risk. Additionally, since many over-the-counter pain products often contain some of the same active ingredients, never use more than one product at a time for pain. Finally, never apply salicylate-containing medications to your skin for use with heating pads or spread on open wounds or breaks in the skin.

People who have recently received the chicken pox vaccine should not use products that contain salicylates. Definitely avoid using salicylates if you are taking gout medications like allopurinol (Zyloprim), febuxostat (Uloric), pegloticase (Krystexxa), or probenecid-containing drugs (Probalan, Col-Probenecid). Consult with your doctor or pharmacist before using products that contain salicylates and/or menthol if you’re taking aspirin, any other OTC medications containing salicylates (like Pepto-Bismol or Kaopectate), trolamine products, and warfarin (Coumadin, Jantoven).

Before purchasing any pain-relieving over-the-counter products, verify the ingredients by checking the back of the product label, or ask your pharmacist to help you make an appropriate selection. Also, because manufacturers may change or discontinue formulations from time to time, make it a habit to periodically re-familiarize yourself with your product of choice, even if you’ve been using it for a long time. If you haven’t checked the label of your favorite product in a while, don’t be surprised if you notice some changes to active ingredients!

Emu oil
Aborigines in Australia have used emu oil for thousands of years, applying the bird’s fat to their skin not only to soothe aches and pains but also to provide a shield from the sun and the harsh elements of the arid Australian climate. Nowadays, the potential uses and benefits of emu oil appear endless. When applied topically, emu oil relieves joint pain and inflammation, soothes shin splints and nerve conditions like sciatica, relieves carpal tunnel syndrome, and eases nerve pain from shingles and rheumatoid arthritis.

Some studies suggest some additional benefits of emu oil, both cosmetic and health-related, when taken internally. For example, emu oil capsules can be taken to lower cholesterol and help support healthy circulation in conditions like atherosclerosis. Applied to the skin, emu oil improves the appearance of keloids, stretch marks, eczema, and dry skin. In anecdotal reports, some users claim that emu oil improves the condition of their hair and stimulates hair growth.

Unfortunately, despite numerous studies done on emu oil, evidence of any benefit of using it to relieve minor aches, pains, and stiffness caused by arthritis along with many other claims appears contradictory and inconclusive.

Emu oil contains the same fatty acids found in fish oil: omega-3, omega-6, and omega-9. These are all essential fatty acids, meaning that the body cannot make them (with the exception of omega-9 in very limited amounts), so you must get these nutrients from your diet. Omega-3 fatty acid decreases inflammation and lowers LDL (or “bad” cholesterol) and triglycerides while increasing HDL cholesterol (“good cholesterol”). Omega-6 or linoleic acid contributes to healthy cellular growth.

Not as much is known about omega-9 or oleic acid’s function in the body as about omega-3 and omega-6 fatty acids. However, oleic acid is thought to help support healthy cholesterol function and possibly play a role in blood sugar control. In theory, all these factors can help relieve pain, but scientists have yet to establish a concrete link between pain reduction and emu oil. Still, many scientists do agree that the presence of these three fatty acids in emu oil may help reduce the inflammation that contributes to the discomfort associated with arthritic joints.

Over the past two decades, various published papers have demonstrated the anti-inflammatory benefit of emu oil in animals, especially regarding the oil’s effect on joint pain, and over-the-counter products for humans that contain emu oil are readily available. Oftentimes, many of these products contain additional analgesic ingredients like camphor and menthol. For example, Blue Emu, an emu oil-containing product commonly found on the shelves, does not have any active ingredients listed on the label. However, this particular product lists many herbs and supplements known to help fight inflammation as general ingredients: horse chestnut seed, methylsulfonylmethane (MSM), and calendula flower (marigold), to name a few.

Information regarding potential drug interactions with emu oil is limited. However, because of its omega fatty acid content, people who are taking NSAIDs like ibuprofen (Motrin or Advil) or prescription blood thinners like warfarin (Coumadin or Jantoven) or dabigatran (Pradaxa) and herbal supplements like garlic, ginseng, and St. John’s wort might want to avoid or limit using emu oil as a dietary supplement.

Despite its animal derivation, few allergic reactions to emu oil have been reported. However, regardless of the emu oil product you’re using, be sure to check the back label to make sure the product doesn’t contain substances that may cause reactions, especially if you have sensitive skin or certain skin allergies. For example, people who are allergic to preservatives like methylparaben or propylparaben or who often have to have creams compounded for their skin might want to consider other options or ask their pharmacist before using such products.

While all of these products might provide you some relief, please bear in mind that you should always seek the advice of a health-care professional before using them. Once you begin, if you don’t seem an improvement in your symptoms over a few days, or if your condition seems to worsen, please see a qualified health-care professional immediately. Don’t be afraid to ask your doctor or pharmacist if you have concerns or questions, and, as always, listen to your body. It will tell you the truth every time.

Frieda Wiley, PharmD, CGP, RPh, is a freelance medical writer based in the Piney Woods of East Texas.


Last Reviewed September 30, 2015

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Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.

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