Patients seek your specialized knowledge and training to help relieve their pain.
Depending on your diagnosis, you may use a combination of adjustments and supplements to make your patients feel better. Your tools may also include a variety of topical analgesics, which you apply during your client’s visit and that you might send home with them.
It’s time to explore the ins and outs of these topicals as there appear to be new ones arriving almost daily.
From the FDA’s perspective
Back in 1983, the FDA issued guidance in its External Analgesic Drug Products for Over-the-Counter Human
Use; Tentative Final Monograph. Apart from periodic updates to this monograph, which serves as an FDA recipe book, a final edict on topicals has not been made. All rules related to the use of medically active ingredients go back to this 34-year-old document.
It is worth noting that, as of the date of this article, there are no updates to this document that include cannabidiol (CBD) oil or homeopathic ingredients as scientifically proven active ingredients for topicals.
Topical analgesics are seen by the FDA as over-the-counter (OTC) products, which means they have at least one FDA-approved active ingredient, and can be sold without a prescription. The key is inclusion of an approved active ingredient. For example, a toothpaste without fluoride is considered a cosmetic because it does not contain a scientifically proven active ingredient.
If you purchase a topical that includes CBD oil, it will be designated OTC if it also includes menthol, camphor or another FDA-approved ingredient. If it does not include one of these ingredients, it may be classified as a cosmetic, which has much lower regulatory hurdles.
FDA-approved active ingredients
If you use an OTC topical analgesic, it likely includes one or a combination of the following approved pain relievers:
- Menthol
- Camphor
- Salicylate
- Lidocaine
- Histamine dihydrochloride
- Hydrocortisone
- Capsaicin (derived from chili peppers)
These and a few dozen others are detailed starting on page 5,867 of the FDA monograph. Included within those pages are permissible strengths.
As a health professional, your training and practice are based in science. You want to know that the products you use in your practice are backed by the scientific method.
FDA-approved ingredients have gone through the rigorous analysis that is required to determine efficacy.
External analgesics
Topical analgesics do not penetrate deeply into the skin, which means that the active ingredients they contain rarely reach the bloodstream in significant concentrations. They provide temporary and effective pain relief without impacting internal organs. Ingested analgesics influence a patient’s whole body, including major organ systems.
This is the reason for caution with acetaminophen, ibuprofen and similar OTC pain killers. Ingested products will relieve pain, but they also carry the risk of side effects, which can be contrary to a holistic medical philosophy.
The pain-relieving mechanism
It is not entirely clear how topical analgesics work. The gate control theory of pain is the leading explanation, but it has gaps that leave some pain-relieving phenomena unexplained.
In any case, the current thinking is that the active ingredients in topical analgesics shut down or mitigate the mechanism within nerve fibers that conveys pain signals to the brain. The end result is that the brain’s pain-sensing mechanism is distracted by the analgesic’s impact, whether it is a warming, cooling, or vasodilation effect.
Unless the analgesic contains an anti-inflammatory ingredient, the topical does not address the under- lying condition that caused the pain and, even then, the inflammation- mitigating effects will be short-term and local. What is clear, however, is that the use of topical analgesics relieves local pain without impacting internal organs.
Using topical analgesics
You are the expert at diagnosing and treating your patients. During your treatment, you may find that permanent pain relief will take some time for your patient. In the meantime, you want to provide him or her with an analgesic that reduces the pain without causing the side effects of an ingested product. In this situation, you can apply an analgesic to the painful area after performing an adjustment.
Ask patients how the analgesic feels and if the pain seems less intense. Also, observe patients to make sure they are not having an adverse reaction.
Because there are cooling analgesics containing only menthol, as well as warming analgesics containing menthol and other ingredients including capsaicin, you may be unsure of which product to apply.
Generally, patients with chronic pain, such as arthritis and lumbago, feel relief from warming products, though some chronic pain patients only get relief from cooling products.
Cooling topicals work well with an acute injury. You may want to experiment so that you get to know the kinds of conditions that each treats best.
Warning: Do not use warming technology or hot towels on patients after applying a topical analgesic. Ultrasound and other heating or hot applications can lead to blistering and burning if used with topical analgesics.
Help patients and increase revenue
As you know, patients who have been in pain for a while before receiving treatment from you can be worried when leaving your office because they worry that their pain will return.
If the topical you applied brought them relief in the office, you can recommend that they purchase a supply for home use so they can apply it as needed before their next appointment. Such a move will improve your patients’ welfare, relieve their stress and bring you additional revenue.
If you see 25 patients a day and half of them benefit from a topical, you could add $600 per week to your practice. You will find that many patients will return to your office to buy topicals even if they have no scheduled appointment.
Patients often turn to chiropractors to find natural ways of obtaining pain relief. As a result, you may want to make sure that your topicals are natural as well.
Dan Sandweiss is COO of Sombra Professional Therapy Products, manufacturer of Sombra brand natural topical analgesics and massage lotions and creams. You can reach him at dan@sombrausa.com and learn more about Sombra at sombrausa.com.
