Yvette C. Terrie, BSPharma, RPh

When patients experience muscle and joint pain, pharmacists can recommend topical analgesics to help provide relief for their symptoms. 

Patients will often use OTC topical analgesics for the treatment and management of musculoskeletal injuries and disorders. These products may have local analgesic, anesthetic, antipruritic, and/or counterirritant effects.

 Counterirritants are approved for the topical treatment of minor aches and pains of muscles and joints. They are often employed for the treatment of acute musculoskeletal injuries and as an adjunct therapy in the treatment of chronic musculoskeletal disorders.

Counterirritants differ from other external analgesics in that pain relief results more from nerve stimulation than depression.

Counterirritants are categorized into 4 groups (Table).

Topical analgesics for musculoskeletal pain can be used alone or in conjunction with oral analgesics when appropriate and warranted. External analgesic products may contain 

or more of the following ingredients: methyl salicylate, camphor, menthol, methyl nicotinate, capsicum, and trolamine salicylate.

Topical analgesic products are available in a variety of formulations, including gels, ointments, creams, lotions, and patches in single-entity or combination formulations. 

 Topical heat therapy patches, such as ThermaCare (Wyeth Consumer Healthcare), are also available in various sizes for treating joint and muscle pain and provide 8 to 12 hours of continual, portable heat therapy. Products new to this OTC category include Icy Hot Spray and Icy Hot Powder Gel (sanofi-aventis), Salonpas Pain Relief Patch (Hisamitsu America Inc), and Bengay Pain Relief + Massage (Johnson & Johnson Consumer Companies Inc). OTC topical analgesics are intended to be used for mild-to-moderate pain for no longer than 7 days, unless otherwise directed by a physician.

The factors that a pharmacist may consider when recommending a topical analgesic include dosage form, cost, ease of use, and odor of product, as well as the patient’s medical history, including possible allergies.

Patients on anticoagulation therapy should be advised not to use topical products that contain salicylates, because concomitant use has been associated with prolonged prothrombin time.

Patients should be advised to use these products as directed and to apply topical products only to intact skin. Areas treated with counterirritants should not be covered with tight bandages or occlusive dressings.

The use of these products should be discontinued if the patient experiences excessive redness or blistering of the skin. Patients should also be advised not to use heating devices in conjunction with topical counterirritants.

 Finally, pharmacists should encourage patients to seek medical care from their primary health care provider if pain worsens or persists after 7 days of self-treatment. PT

1. Wright, Eric. Musculoskeletal Injuries and Disorders In: Berardi R, Newton G, McDermott JH, et al, eds. Handbook of Nonprescription Drugs. 16th ed. Washington, DC: American Pharmacists Association; 2006: 94-113.

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

Articles

Understanding Topical Analgesics

Pharmacists can counsel male patients on the appropriate way to incorporate multivitamin/multimineral supplements formulated for men into a nutritional plan.

The use of multivitamin/multimineral supplements is a growing trend in the United States, as an estimated one third of adults use these supplements on a regular basis

 The American Dietetic Association position to promote optimal health and decrease or prevent the risk of chronic medical conditions is to consume a diet that contains a wide variety of nutrient-rich foods.

 Their position also states that obtaining additional nutrients from supplements may be beneficial to some individuals in meeting their nutritional needs, as specified by science-based nutrition standards such as the Dietary Reference Intakes from the Institute of Medicine.

While many individuals use nutritional supplements, a 2009 report from the US Government Accountability Office stated that “according to experts, consumers are not always well-informed about the safety and efficacy of dietary supplements and may sometimes have difficulty interpreting labels on these products.”

 Therefore, pharmacists can be a vital resource for those individuals electing to use a nutritional supplement by assisting in their selection and proper use.

Currently, many manufacturers market supplements specifically for men in various age groups, including formulations for teenagers, men aged 50 years and younger, and men older than 50 years. Supplements formulated for adult men contain key nutrients, such as vitamins B6, B12, C, and E and folic acid to support cardiovascular health; vitamins A, C, and E and the mineral zinc for ocular health; and vitamin C, calcium, magnesium, and higher levels of vitamin D to promote healthy blood pressure levels.

 Typically, supplements formulated for men do not contain iron.

The supplements marketed for teenagers include key nutrients for optimal health during this phase of life, such as magnesium for healthy muscle function, as well as calcium, vitamin D, and magnesium for bone strength.

One of the newest supplements for men is One A Day Men’s Pro Edge (Bayer Healthcare), which is formulated with key nutrients to meet the nutritional needs of those men who routinely exercise or engage in sports.

In general, supplements formulated for those older than 50 years may include larger amounts of vitamin C, folic acid, vitamin D, vitamin E, and vitamins B1, B2, B6, and B12, but no iron, since individuals in this patient population generally require less iron and meet their iron needs through their diet alone.

 Some studies have suggested that high iron stores may in fact contribute to conditions such as cancer and cardiovascular disease; however, research to date is inconclusive.

Supplements formulated for men older than 50 years may also contain ginkgo for memory and concentration function.

Prior to recommending any multivitamin/ multimineral supplements, pharmacists should assess the patient’s medical history and medication profile to determine if there are any existing contraindications or potential for drug/micronutrient interactions. They should also remind patients to take these supplements as directed.

Finally, pharmacists should stress the importance of incorporating a balanced nutrition plan into their patients’ daily routine and provide a referral to a registered dietitian when necessary.

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia. 

		Marra MV, Boyar AP. Position of the American Dietetic Association: nutrient supplementation. 

		One a Day Vitamins 50+ Advantage [product information]. Bayer Consumer Web site. Available at: http://oneaday.com/mens_50.html. Accessed June 1, 2010.

		Centrum Silver [product information] Wyeth Consumer Health Web site. Available at: www.centrum.com. Accessed June 1, 2010.

		One A Day Vitamins for Teens [product information]. Bayer Consumer Web site. Available at: www.oneaday.com/teen_advantage.html. Accessed June 1, 2010.

		Huckleberry Y and Rollins C. Essential and conditionally essential nutrients. In: Berardi R, Newton G, McDermott JH, et al, eds. 

Handbook of Nonprescription Drugs 16th ed

. Washington, DC: American Pharmacists Association; 2009:389-417.

		One A Day Vitamins [product information] Bayer Consumer Web site. Available at: www.oneaday.com. Accessed June 1, 2010.

		Ervin RB, Kennedy-Stephenson J.Mineral intakes of elderly adult supplement and non-supplement users in the third national health and nutrition examination survey. 