Some people seek out non-conventional treatments for chronic pain, as Victoria Goldman explains…

According to the most-recent NICE guidance, topical non-steroidal anti-inflammatory drugs (NSAIDs) should be the first-line pharmacological treatments for osteoarthritis. If topical medicines are ineffective or unsuitable, patients can try oral NSAIDs instead.

However, not everyone can, or wants to, take or use conventional anti-inflammatories, whether topical or oral, on a regular basis.

Some people either continue to suffer from chronic pain or look for non-conventional treatments. The use of many herbal or natural topical anti-inflammatory products (sprays, gels, creams and patches) isn’t always backed by clinical research, although many people find these improve their mild to moderate pain, not just caused by arthritis but skin conditions as well.

“Some herbs have anti-inflammatory properties similar to NSAIDs such as ibuprofen but without the risk of gastric complications that can sometimes be associated with their long-term use,” says Dr Dick Middleton, a pharmacist and director of the British Herbal Medicine Association.

“It’s important to always choose a herbal medicine displaying the THR symbol on its packaging for quality and safety assurance.”

Joint and muscle pain

Topical products containing menthol are used as analgesics by people with a wide range of conditions, including back pain, joint pain, migraine and sports injuries. Menthol, along with capsaicin and camphor, are counterirritants.

At low concentrations, menthol activates cold receptors in the skin, causing a cooling sensation and a weak anaesthetic effect. Using ice and related topical cold products (sprays, gels or pads) can have a similar effect. Research shows that menthol also has anti-inflammatory properties.

“Peppermint and spearmint essential oils have been suggested to have a role when used topically for headaches and for osteoarthritic pain,” says Dr Etheridge, medical herbalist and chair of the BHMA. “Frankincense (Boswellia) essential oil has also been shown to have a potential role in the treatment of knee osteoarthritis, carpal tunnel syndrome and for the reduction of episiotomy pain.”

Capsaicin is a natural chilli pepper extract that triggers a heat sensation when applied to the skin. It causes pain relief mainly by reducing levels of a pain transmitter called substance P. Research shows that topical capsaicin is particularly effective when used with topical diclofenac. It can cause an initial unpleasant burning sensation.

“There is evidence that capsaicin can be helpful in the treatment of neuralgia, diabetic neuropathy, dialysis-induced itching, psoriasis, fibromyalgia, osteoarthritis, post-amputation pain, postmastectomy pain syndrome and the pain after shingles (post-herpetic neuralgia),” says Dr Etheridge.

“A review of the topical use of capsaicin backed up its use for neuralgia, neuropathy and osteoarthritis. Medical herbalists can supply this cream which, of course, has to be used with great care.”

New Zealand green lipped mussels are a source of omega-3 fatty acids, which have anti-inflammatory properties, and may be combined with other ingredients such as menthol or glucosamine. According to the Versus Arthritis charity, evidence suggests topical products containing New Zealand green lipped mussel extracts may help people with osteoarthritis when taken with paracetamol or NSAIDs, but these are not effective in treating rheumatoid arthritis.

Arnica is a traditional herbal medicine used for the symptomatic relief of rheumatic pain, muscular pain and stiffness, backache, fibrositis, bruising, cramp, sprains and minor sports injuries. It comes as an ointment, gel or liquid that can be rubbed into the affected area of skin several times a day.

“Despite the long history of use, particularly in Europe, only a small amount of clinical research exists,” says Dr Etheridge. “A 2014 randomised controlled trial looked at the effects of topical arnica on performance, pain and muscle damage after intense eccentric exercise in 20 males. The study found that topical arnica reduced pain and muscle tenderness three days after intense exercise.

“A 2021 review found some evidence that arnica could be helpful for post-surgical pain, and hand and knee osteoarthritis.”

Glucosamine and chondroitin are usually taken orally, but they can also be used topically as anti-inflammatory agents for osteoarthritis-related pain and joint inflammation. Other topical natural products for joint pain may contain magnesium, or a combination of essential oils.

Natural skincare

Witch hazel water is traditionally used as a skin cleanser and astringent. It can also stop minor bleeding and is often used for bruises, sprains, spot-prone skin and acne.

Aloe vera gel reduces skin inflammation and encourages wound healing. Several studies have highlighted the benefits of using it on burn wounds to relieve itching and pain. It may also moisturise the skin and restore dry and damaged skin, which is why it’s often found in products for scarring, stretch marks, chapped skin and sunburn.

Colloidal oatmeal can be added to bathwater for the temporary relief of itching and inflammation caused by eczema, psoriasis and dry skin. It’s also added to skincare products, such as creams, cleansers and lotions.

Its active ingredients have potent antioxidant and anti-inflammatory properties and may help to restore the skin’s natural moisture levels.

Herbal ointments containing German chamomile can be used to treat mild skin irritation and inflammation. Yarrow is traditionally used as an anti-inflammatory for muscle, back and joint pain, while marshmallow extracts may help with skin irritation caused by dry skin and eczema.

Conventional options

Our research shows 79 per cent of Brits suffer from disrupted sleep thanks to joint or muscle pain. Topical analgesics are a great option because they are targeted. For example, topicals including ingredients such as levomenthol that soothes and cools, together with ibuprofen which helps to tackle pain and inflammation, ticks the boxes for those customers with mild to moderate pain issues.

Consumers should also opt for topical products that are backed by evidence and work in more than one way, such as having triple-action formulations. For consumers looking for night-time relief, recommending patches with new technologies such as hydrogel which provides up to 12 hours relief, is great news plus they can be used alongside any medication.

Elaine Walker, senior brand manager, Deep Relief.