Effects of Biofreeze pain reliever and chiropractic adjustments on acute low back pain: a pilot study

John Zhang MD, PhD; Dennis Enix DC; Brian Snyder DC; Kristan Giggey DC; Rodger Tepe, PhD

Abstract

Low back pain (LBP) symptoms are extremely common, affecting as much as 80 percent of the population at some time in their lives.¹ Diversified chiropractic adjustment is one of the most frequently used adjusting techniques in the chiropractic management of LBP. There is sufficient evidence that diversified adjustment may reduce LBP.

Biofreeze topical analgesic has also been used as an adjunct therapy in chiropractic management of low back pain. Topical analgesics are often recommended for minor pain control because of their lower risk of side effects compared to nonsteroidal anti-inflammatory (NSAID) drugs.² However, the pain-reducing effect of Biofreeze products, in conjunction with chiropractic treatment, had not been studied.

Researchers at Logan College of Chiropractic wanted to determine whether Biofreeze gel has a pain-reducing effect when added to the treatment protocol of chiropractic adjustments in patients with LBP. Thirty-six patients with acute low back pain were randomly assigned to chiropractic only and chiropractic combined with Biofreeze gel application.

This study showed that when combined with chiropractic care, Biofreeze gel significantly reduced low back pain compared to the chiropractic-only group. There were no significant differences in disability between the groups.³

According to the FDA, menthol is a safe and effective over-the-counter topical analgesic.⁴

Menthol, the key ingredient in Biofreeze gel, is thought to reduce pain through a counter-irritant effect. When applied to the skin, counter-irritants block the sensation of pain through the Gate Control mechanism.⁵ Menthol may also reduce pain by stimulating cold receptors known as TRPM8, which are involved in pain control.⁶

Chiropractors should consider adding home-application and clinical application of Biofreeze pain reliever to the management of their patients with low back pain. As an adjunct, Biofreeze products can be used before and after interventions such as adjustments, ultrasound, and laser therapy.

Objective: This randomized controlled study was designed to determine the pain-relieving effect of Biofreeze pain reliever⁷ body surface application and chiropractic adjustments on subjects with acute LBP.

Methods: The data were collected at the baseline, two weeks after treatment, and four weeks after treatment for final analyses. Diversified manual adjustments were provided by licensed chiropractors twice a week for four weeks to both control and experimental groups.

Biofreeze was applied to the lower back area three times a day for four weeks in the experimental group. Outcome assessments included visual analog scale, Roland Morris Disability Questionnaire, heart rate variability for stress, and electromyography for low back muscle activity.

Results: A total of 36 subjects were recruited in the study (25 male). The average age was 34 years. Significant pain reduction was found after each week of treatment in the experimental group (P .05) in the experimental group after four weeks of Biofreeze and chiropractic adjustments. There were no statistically significant changes in the electromyography readings between the two groups.

Conclusion: Biofreeze combined with chiropractic adjustment showed significant reduction in LBP.

¹Macfarlane GJ, Thomas E, Croft PR, Papageorgiou AC, Jayson MI, Silman AJ. Predictors of early improvement in low back pain amongst consulters to general practice: the influence of pre-morbid and episode-related factors. Pain 1999;80(1-2):113-9.

²American College of Rheumatology. Recommendations for the medical management of osteoarthritis of the hip and knee. Arthritis Rheum. 2000. 43(9):1905-1915.

³Zhang J, Enix D, Snyder B, Giggey K, Tepe R. Effects of Biofreeze and chiropractic adjustments for acute low back pain: a pilot study. J Chiropractic Med. 2008. 7:59-65.

⁴ Patel T, Ishiuji Y, Yosipovitch G. Menthol: a refreshing look at this ancient compound. J Am Acad Dermatol. 2007; 57:873-8.

⁵Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150 (699):971-9

⁶ Proudfoot CJ, Garry EM, Cottrell DF, Rosie R, Anderson H, Robertson DC, Fleetwood-Walker SM, Mitchell R. Analgesia mediated by the TRPM8 cold receptor in chronic neuropathic pain. Curr Biol. 2006 Aug 22;16(16):1591-605.

⁷This study was funded by the Logan College of Chiropractic. Biofreeze was provided by Performance Health, Inc. to patients free of charges. No conflicts of interests exist in the study. The main finding of the study supports the use of Biofreeze in patient with acute low back pain.

⁸Abstract reprinted from Journal of Chiropractic Medicine (2008), 7, 59-65, with permission from Elsevier.

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This research was provided by Performance Health/Hygenic Corporation