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Give patients home heat therapy with a topical gel recommendation

A topical gel has an advantage over the unpleasant side effects of oral NSAIDs and prescription pain killers that many patients...

A topical gel has an advantage over the unpleasant side effects of oral NSAIDs and prescription pain killers

A regular exercise routine is a vital part of any wellness plan you set up for your patients. But some patients can use a topical gel to get through the soreness of a return to exercise. Exercise not only promotes good cardiovascular and joint health, but can also improve mental health and emotional wellbeing.

While this is good advice for your patients to follow, many of them may be coming back to athletics and experiencing return-to-activity pains. Additionally, they may have ongoing, chronic musculoskeletal issues with stiff, sore joints and muscles, serving to hamper enthusiasm to work out on a regular basis.

Alternatives to NSAIDs

There is a wide array of topical gels that are designed specifically to help loosen stiff and sore joints, making movement feel smoother and more natural. While topical nonsteroidal anti-inflammatory (NSAID) gels are available, they can have unpleasant side effects and are also not recommended for patients who are already taking oral NSAIDs on a regular basis.1

Fortunately, there are alternatives that work to help loosen stiff joints prior to exercise, but without the side effects associated with NSAIDs. Some topical gels have a warming action and help provide more blood to the affected area, reducing pain and stiffness, as well as making the joint move more smoothly.

Ingredients to look for:


Capsaicin is the active ingredient that provides the “heat” in chili peppers. It also has counter-irritant properties, which work at the outer dermal level to distract the brain from the more serious pain or soreness at deeper levels.2

A 2018 literature review published in Reumatologia Clinica examined the results from several studies to look for commonalities among the findings to strengthen the overall results for the use of capsaicin gel in the treatment of osteoarthritis.2 Overall, the researchers found that topical capsaicin analgesics were both effective and safe for treating osteoarthritis in a variety of treatment areas, such as hands, knees, hips or shoulders. Furthermore, side effects were mild, generally consisting of a burning sensation that decreased over time.2


Camphor was distilled from the bark and wood of the camphor tree in ancient times, but today is derived from turpentine.3 It is often used in combination with menthol to provide a cooling sensation, followed by heat.  

At low concentrations (0.1% to 3%), camphor works as an anesthetic, while at higher concentrations of greater than 3%, it works as a counterirritant, similar to capsaicin. Camphor should not be used internally or applied to broken skin, as it can be toxic if built up inside the body.3

Topical gel: proper application and cautions

Patients should apply the gel to the affected area before starting their warm-up exercises. For extra heat therapy, they can also use a hot rice bag for approximately five minutes prior to applying the topical gel. Patients should also wear gloves to apply the topical gel, taking care to avoid sensitive areas, such as the eyes. If either capsaicin or camphor gel does get in the eyes, flush them with water, but do not rub, as that will only irritate them further.

Regular exercise is always an excellent way to improve overall health, and is even more vital in stressful times. While doing so may be more difficult for patients with musculoskeletal issues, using a warming topical gel before exercising may help them keep active and in good mental and emotional shape.


  1. Arthritis Foundation. Topical NSAIDs offer joint pain relief. Accessed 6/25/2020.
  2. Guedes V, Castro JP, Brito I. Topical capsaicin for pain in osteoarthritis: A literature review. Reumatologia Clinica. 2018;14(1):40-45.
  3. WebMD. Camphor. Accessed 6/25/2020.

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