Although back or neck pain are more common than shoulder pain, this does not diminish the frustration your patients feel when they experience nagging shoulder pain.
Regardless of the cause, shoulder pain can interfere with your patients’ activities of daily living, such as dressing, bathing or showering, or personal grooming activities such as brushing their hair.
Shoulder pain can also affect your patients’ ability to properly perform their work, particularly if it requires them to spend most of their time working on a computer. Even weekend warriors can be sidelined from their favorite athletic activities as a result of soft tissue shoulder pain. Fortunately, many topical analgesics are well-suited for treating shoulder pain.
Common shoulder conditions treated with topical analgesics
Obviously, certain shoulder issues, such as a dislocated shoulder, cannot be primarily treated with a topical analgesic. However, pain that results from overuse or overstretching are the most common causes for patients to come to see you with a chief complaint of soft tissue shoulder pain.
In most instances, the culprit is either a repetitive use or an athletic injury. Patients with arthritis, tendonitis, or bursitis of the shoulder may also benefit from topical analgesics.
Types of topical analgesics
There are several different types of topical analgesics, each of which works in different ways, depending upon your patients’ needs.
Salicylates: These topical analgesics contain the same ingredients as in aspirin and NSAIDs, although in much lower amounts. They are particularly good for joints close to the surface of the skin, such as knees and elbows.
Counter-irritants: Topical analgesics that produce a cooling sensation fall into this category. They usually contain menthol, camphor, or eucalyptus oil. These work well right away, but are usually not recommended for chronic shoulder pain.
Capsaicins: This category of topical analgesics produces a warming sensation from chili pepper oil, which can help ease joint pain or nerve damage in the shoulder. Topical analgesics with capsaicin generally require several applications to have a long-term effect, so are better suited for chronic shoulder conditions, such as arthritis or frozen shoulder.
How do topical analgesics work?
Topical analgesics actually work by tricking the brain into ignoring pain signals. They stimulate a particular neuron receptor in the brain to lessen the pain sensation on the shoulder.1 Although the skin temperature on the shoulder will not have changed, the patient experiences a sensation that it processes as relief from pain.
In fact, a 2012 study in the International Journal of Sports Physical Therapy compared a menthol topical analgesic to ice for athletic injuries and found that the topical analgesic offered significantly better results.2
Advantages of topicals for soft tissue shoulder pain
The main advantage for topical analgesics is that they deliver pain relief directly to the shoulder. In comparison, aspirin or NSAIDs must first be absorbed into the body before they can begin to relieve pain. Because topical analgesics go directly to the affected area, your patients should feel results almost instantaneously.1
Topical analgesics also can be used with far lower risk of side effects. Unlike oral aspirin or NSAIDs, which may cause gastrointestinal issues for your patients, some topical analgesics only contain a minute amount of these painkillers, so are far less likely to cause issues.1
This low side effect profile also makes topical analgesics an excellent option for pediatric or geriatric patients, as well as those who don’t wish to add more oral medications to those they are already taking.
Finally, topical analgesics are an excellent way for your patients to enhance their chiropractic care by using them between regular visits for shoulder joint adjustments. This is particularly beneficial for those of your patients with chronic shoulder issues.
Combined with the use of either ice or heat, and self-massage, topical analgesics can help your patients get their shoulder back into full swing.
1. D. Rub-on pain reliever can ease arthritis discomfort. Harvard Health Blogs. Accessed 12/15/2018. Available at https://www.health.harvard.edu/blog/rub-on-pain-reliever-can-ease-arthritis-discomfort-201301185817
2. Johar P, Grover V, Topp R, Behm DG. A comparison of topical menthol to ice on pain, evoked tetanic and voluntary force during delayed onset muscle soreness. International Journal of Sports Physical Therapy. 2012;7(3):314-322.