Incorporating topicals for back pain into your practice

Low back pain is the number one cause of disability around the globe according to the World Health Organization.

Musculoskeletal conditions in general are the second most-cited reason behind disability, the latter of which affects one in five people worldwide.

Though individual causes of pain experienced in this area of the body vary, a 2017 survey conducted by Statista found that American adults named stress as the main source of their pain (29 percent). Other factors respondents reported as contributors also included:

• Having weak muscles or not getting enough exercise (26 percent)
• Pain resulting from physical work (26 percent)
• Being overweight (25 percent)
• Sitting at a desk at work (20 percent)

Another 2017 Statista survey reported that approximately one out of every two people experiencing back pain (49 percent) use painkillers as their method of relief. This exposes them to risks commonly associated with this category of drugs, some of which include increased chances of having a cardiovascular event, GI bleeding, suffering more fractures, and even death according to the National Safety Council.

One option for relieving back pain without being exposed to these sometimes-life-threatening side effects is topicals.

Topicals: What they are and how they work

Topicals are oils, creams, lotions, and gels that contain a number of ingredients which, when applied to the skin, can provide the user with pain relief. Additionally, because they are only applied to the pained area and aren’t distributed via the bloodstream, the entire body isn’t subjected to their effects.

The Mayo Clinic explains that these types of pain-relieving topicals generally fall into one of three categories:

1. Capsaicin. This type of topical provides pain relief by reducing chemicals within nerve cells that are typically responsible for instigating a pain response.
2. Salicylates. Topicals containing salicylates (of which aspirin is one) have not been tested rigorously for their effects on pain according to Harvard Medical School, yet goes on to say that “there’s not much question that once a salicylate compound is absorbed and metabolized into salicylic acid, it has some effect on pain and inflammation.”
3. Counterirritants. If the pain relieving topical contains a counterirritant such as menthol or camphor, the Mayo Clinic shares that it works by creating a hot or cold sensation that ultimately overrides the body’s ability to feel pain.

Topicals for back pain

How effective are topicals for back-related pain? In November 2003, the journal Pain published a study involving 320 individuals with non-specific low back pain. One-half were treated with a capsicum topical and the other half received a placebo.

After three weeks, the group treated with the topical containing the active ingredient experienced a 42 percent reduction in their compound pain subscores. Eighty-two percent of these also reported that they were “symptom-free.”

A 2008 study published in Molecular Pain found similar positive results. In this case, participants were included in the study if they reported experienced chronic back pain for more than three months and their level of pain was at least 30 out of 100 on a visual analog scale.

Upon completion of the two-week study, researchers noted that those using topical treatments experienced “a robust decrease in pain intensity as well as other clinical pain parameters.”

Easing the opioid crisis

Studies have also found that using topicals for pain-related conditions has a positive impact on individual’s use of pain medication. For instance, in January 2018, the Postgraduate Medicine journal revealed the results of a study involving 121 patients on opioids for chronic pain.

After three months of treatment with topicals, almost one-half of the study participants (49 percent) reported that they no longer used opioids to help control their pain. Thirty-one percent indicated that they wound up stopping the use of all of their pain medications.

When participants were questioned six months post-treatment, 56 percent stated that they had effectively discontinued opioid use and 30 percent eliminated their use of pain pills completely. Their pain severity scores decreased as well.

Safe topical application

When applying topical medications, the Institute for Safe Medication Practices (ISMP) shares that they should not be applied to areas where the skin is damaged or irritated. Bandages, plastic wraps, and heat sources should also not be used over areas of topical use.

The ISMP further recommends taking necessary precautions so the topical does not come into contact with the eyes, nose, mouth, or genitals. Additionally, the directions for that individual topical should be followed closely and, if any pain is experienced, use should be discontinued.