Ouch – that hurts……

It has been a long winter and spring is in the air. The garden beckons, the house screams for a new coat of stain, the kayak begs for attention……in a moment of irrational haste you toss down your novel, splash on your sunscreen and dash outside to experience the exhilaration of outdoor activity. By day’s end you hit the bed, tired but happy for the ability to be outside once again. The next morning you find that happiness has evaporated – replaced by unhappy, aching muscles, tendons or joints.

OK so I am just guessing at the scenario above, but we have been getting a lot of questions about medicines for aches and pains and what the differences are among the various over-the-counter products, so I filled in a blank or two. Poetic license.

Let’s start with anti-inflammatory medications. These wonderful little pills help lessen your body’s response to injury by relieving the pain and swelling caused either by wear and tear over time (as from arthritis) or from a sudden trauma (e.g. falling off a ladder). Drugs with anti-inflammatory properties include: ibuprofen (Motrin®), naproxen (Aleve®), and aspirin. Things to remember – always take with food, don’t lie down within 40 minutes of taking, don’t mix different types of anti-inflammatory meds, don’t take if you take blood thinners (warfarin), and some (e.g. ibuprofen and naproxen) can cause sun sensitivity. These medications interact with some prescription medications so check with your pharmacist before taking if you are taking prescriptions.

Another medication that may help with pain and discomfort is acetaminophen (Tylenol®), also known as APAP. APAP doesn’t have any anti-inflammatory activity so while it may help with pain, it won’t lessen swelling. However, it is much safer than aspirin, ibuprofen or naproxen if you take warfarin. Additionally, APAP doesn’t have any problems with sun sensitivity.

Next come some of the “fixes” that aren’t so quick – namely glucosamine, chondroitin and MSM. It is thought that glucosamine and chondroitin work in perhaps two ways – they may stimulate the production of cartilage building proteins to help us replace what we have lost in those pesky, aching joints and they may also help inhibit the production of cartilage destroying enzymes that cause us to lose some of the cartilage we have. MSM (methylsulfonylmethane), a by-product of DMSO (remember DMSO, the 70’s and racehorses?) is thought to be a more readily usable source of sulfur, which, in turn, is used by the body to maintain healthy connective tissue which makes for a healthier joint. The problem with these products is three-fold: 1) the studies to validate their efficacy are conflicting (some support their use, others show no benefit), 2) since they are “dietary” supplements and not drugs, the content of products can vary widely, 3) if they do work, they seem to take longer to have a positive effect.

Bottom line: most medical authorities regard the use of these compounds as plausible and agree more study is needed. So if you want to give them a try for 2-3 months, they may help. If you see no benefit after 3 months, I’d try something else. Diabetics should monitor blood sugar if taking glucosamine as “on paper” it can worsen insulin resistance. (So far, this doesn’t seem to be the case in practice, but best to be fore-warned.) Glucosamine is made from shellfish shells; individuals allergic to shellfish should take with caution. Chondroitin may cause problems in patients taking blood thinners.

One last thing to consider trying on those aches and pains is topical treatments. The muscle rubs like BenGay® and IcyHot® give the sensation of either warmth or cool and warmth to help loosen tight muscles. If nothing else they may help you feel more comfortable. MSM topical creams claim to help a variety of problems including muscle aches, inflammation and pain. We need more studies to document effectiveness, but for most it would be OK to give it a try. DMSO applied topically has long been used in the horse racing industry to help sore joints and is still available. Note that topical application of DMSO can give you an almost instant bad taste in your mouth. Additionally DMSO is a powerful transdermal agent, which means it can carry anything it touches through your skin and into your body. Yuck! I recommend steering clear of DMSO. Another option is Arnica, a homeopathic remedy used for a variety of ailments, including trauma, pain relief, swelling and bruising. It is available both topically and as a sub-lingual tablet. Once again studies are inconclusive and more trials are needed. Anecdotally we get a lot of positive reports on applying arnica topically to bruised or aching muscles.

Keep in mind that if you continue to perform any painful activity, whatever is injured may not have a chance to heal. Run any unexplained or longer lasting muscle aches or pains by your doctor or pharmacist as some medications cause muscle pain as a side effect and pain can also be an indicator of something more serious. Too much of anything is not a good thing so remember to read and follow label directions to avoid potential problems with overdosing. AND – call your pharmacist if you have any questions.