Cetyl myristoleate (CMO) is a fatty acid, an ethylated esterified fatty acid derived from bovine tallow oil. Though it is similar to fish oil, it is made specifically to help joints through its action as a cellular lubricant. Clinical studies show CMO to be an effective natural anti inflammatory compound that promotes healthy joint function. It increases joint flexibility and range of motion by lubricating the joint at a cellular level. It works to decrease inflammation specifically in the joints and lubricate their movement. In other words, it increases the fluids that cushion the space between the joint bones. CMO is reported to effect change at the cellular level, within the cell membranes themselves. It assists in the reduction and prevention of breakdown in joint cartilage. This can be especially helpful for those suffering degenerative osteoarthritis. The Journal of Rheumatology reported on a double-blind study of patients with chronic knee osteoarthritis where the CMO group saw significant improvement while the placebo group saw none. In fact, the scientists were so impressed with the results they concluded CMO “may be an alternative to the use of non-steroidal anti-inflammatory drugs for treatment of osteoarthritis.”

Acetylsalicylic acid works by irreversibly disabling the COX enzymes to block the cascade [Figure 1]. NSAIDs have evolved from blocking both COX-1 and COX-2 to selectively only blocking COX-2 in order to inhibit the inflammatory response and reduce the production of inflammatory prostaglandins and thromboxanes. The major push to develop the selective COX-2 inhibitors has been the recognition of significant complications associated with the nonselective COX-1 and COX-2 NSAIDs. Nonselective NSAIDs’ major side effects include significant gastrointestinal upset, gastritis, ulceration, hemorrhage, and even death. By locking COX-1, which also normally acts to protect the gastrointestinal mucosa, nonselective NSAIDs and aspirin can cause significant gastric tissue damage.[34,51,78,91,3,101,115]

if you are having surgery, including dental surgery, tell the doctor or dentist that you are using diclofenac gel (Voltaren) or liquid (Pennsaid).plan to avoid unnecessary or prolonged exposure to real or artificial sunlight (tanning beds or lamps, ultraviolet light) and to wear protective clothing to cover areas treated with diclofenac gel (Voltaren) or liquid (Pennsaid). Diclofenac may make your skin sensitive to sunlight.
A study involving 120 people with acute upper or lower back pain showed that rubbing in comfrey cream, three times a day for 4 to 6 days, reduced pain intensity by 95%, compared with just 38% reduction for inactive ‘placebo’ cream. Comfrey works quickly, providing good pain relief within an hour of application. In fact, researchers have found that comfrey cream is more effective than a prescribed, non-steroidal anti-inflammatory treatment (diclofenac gel) for treating ankle sprains.
One of the problems with pain relief creams is that application can become messy. It can be difficult to keep the cream contained to the area of skin that needs treating, and if you get the product on your hands, it’s easy to accidentally rub it into the eyes, which can be painful! To the rescue: Roll-on formulas, like Outback All-Natural Pain Relief, which allow for hands-free and targeted pain relief. The product contains just four ingredients: tea tree oil, vanilla, eucalyptus, and olive oil. The ingredients ease pain by reducing inflammation.
Limited bed rest. Once the mainstay of treatment for back pain, bed rest has fallen out of favor. Doctors now know it's better to keep moving, so that your muscles don't become stiff. Bed rest can still be useful relief from low back pain, particularly if your pain is so severe that it hurts to sit or stand. But try to limit it to a few hours at a time and for no more than one or two days.

Diclofenac is also available as a 3% gel (Solaraze; generic) that is applied to the skin to treat actinic keratosis (flat, scaly growths on the skin caused by too much sun exposure). This monograph only gives information about diclofenac gel (Voltaren) and liquid (Pennsaid) for osteoarthritis. If you are using diclofenac gel (Solaraze, generic) for actinic keratosis, read the monograph entitled diclofenac topical (actinic keratosis).

When used together, menthol and methly salicylate create vasodilation (opening of the blood vessels) close to the surface of the skin.  Increased blood flow to the area of application is said to have pain-killing on the nerve receptors in the treated area.  When combined, these two ingredients also work together to form a class of treatment called counterirritants. Counterirritants work by tricking the body into feeling sensations other than pain. The menthol and methyl salicylate in muscle creams create conflicting feelings of warmth and cold. When the nervous system sends both of these sensations, at the same time, they compete with and ultimately block pain signals from travelling to the brain.  Together these ingredients, when delivered in muscle creams or sports balms, work to create a powerful 1-2 punch, killing pain and providing relief to aching muscles and joints.
While these are not the only risks NSAID medications, they are somewhat more common, and some of the more worrisome, side effects. It is always safest to have a discussion with your physician if you have any concerns about the risk of taking these medications. It is important to understand that even in healthy people without underlying medical conditions, there is always the risk associated with any medication. The benefits of taking an anti-inflammatory medication need to be balanced with the possible risks of taking the medication.

When sudden changes occur in the weather or we overexert ourselves during physical activity, those of us who experience, or who already had, muscle and/or joint pain treat ourselves with the traditional prescriptions of conventional anti-inflammatories. There is a general tendency for us to take anti-inflammatories every time something hurts, as if they were water. Nevertheless, the damage caused to our bodies (liver, stomach, etc.) by anti-inflammatories is highly significant if these are abused. Symptomatic use of analgesics, such as paracetamol, and non-steroidal anti-inflammatory drugs (NSAIDs) is almost always the first treatment option, and ibuprofen is one of the most widely used anti-rheumatic drugs.
Acetylsalicylic acid works by irreversibly disabling the COX enzymes to block the cascade [Figure 1]. NSAIDs have evolved from blocking both COX-1 and COX-2 to selectively only blocking COX-2 in order to inhibit the inflammatory response and reduce the production of inflammatory prostaglandins and thromboxanes. The major push to develop the selective COX-2 inhibitors has been the recognition of significant complications associated with the nonselective COX-1 and COX-2 NSAIDs. Nonselective NSAIDs’ major side effects include significant gastrointestinal upset, gastritis, ulceration, hemorrhage, and even death. By locking COX-1, which also normally acts to protect the gastrointestinal mucosa, nonselective NSAIDs and aspirin can cause significant gastric tissue damage.[34,51,78,91,3,101,115]
Massage: There's an upside to your discomfort: It's a legit excuse to get a weekly massage. One study found that people who did had less lower back pain and disability after 10 weeks, compared with the control group—and general relaxation rubdowns worked just as well as structural massage targeted at specific parts of the body. Osteopathic and chiropractic therapies—in which joints and muscles get stretched and repositioned—have been shown to work, too. In a study published in the Annals of Family Medicine

Relief goes beyond common sport and muscle creams to relieve your pain.  With the highest level mixture of menthol and methyl salicylate of sports creams and balms, Relief quickly starts working.  Just one application of our non-greasy, no mess applicator provides the temporary relief you have been looking for.  Simply rub the balm on directly from the container – no more messy hands.  We take time tested ingredients that work and deliver them in an easy to use applicator to alleviate your muscle and joint pain.  Pick up some Relief and don’t let pain stop you.


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Hi Patricia, Sorry to hear about your experience. The patient information leaflet for diclofenac gel inside each pack advises that users should avoid applying on large areas of skin, that an amount ranging in size from a 1 penny to a 2 pence piece will usually be sufficient, and not to use it if you are already taking NSAID tablets. High blood pressure is not listed as a possible side effect, as this was not detected in clinical trials. As you say, diclofenac tablets and other oral NSAIDs are now associated with an increased risk of cardiovascular disease which is why the gel is considered a better option. I have coverd this in a post about ibuprofen increasing blood pressure here. Research looking into the long-term tolerability of topical diclogenac gel in people with an elevated risk of NSAID-related side effects, such as existing high blood pressure, type 2 diabetes, stroke and heart disease, suggests that the gel appears to be safe to use to treat osteoarthritis, even in these high risk groups. Having said that, everyone is different, due to the genes they have inherited, and you may have experienced an unusual, idiosyncratic reaction to the small amounts absorbed via the skin. It’s good that you or your doctor were monitoring your blood pressure to detect this. I have a website dedicated to lowering a high blood pressure, which includes lots of complementary approaches, that you may find helpful. Are you able to share the name of the herbal cream which you have found works better? Best wishes, Sarah B
The use of non-steroidal anti-inflammatory drug (NSAID) medication is still the mainstay of most classically taught clinicians for joint and spine related inflammatory pain, despite their commonly known side effects [Table 1]. NSAID mechanisms are primarily through interaction with proinflammatory cytokines interleukin (IL)-1a, IL-1b, IL-6 and tumor necrosis factor (TNF-α). Increased concentrations of TNF-α are believed to cause the cardinal signs of inflammation to occur.[44]
Topical glucosamine cream and gel can significantly reduce the pain of knee osteoarthritis within 4 weeks. One study involving a glucosamine cream found that 100% of those with arthritis of the shoulder gained benefit. Of those with arthritis of the ankle, wrist or elbow, glucosamine cream reduced pain in 75% of people, and it worked in 58% of those with knee osteoarthritis.

“I had sciatic pain so bad that I went to a doctor for a 'series of three shots' (or so he said) for the pain, yet ten shots later the pain was still there. When a friend of mine gave me a tube of Relief pain cream that had a little left in it so I could give it a try I was so amazed at how effective it was in relieving my pain that I immediately called and ordered two tubes, and I will be asking my doctor to stock it—because I absolutely love this stuff!" *
These proinflammatory cytokines result in chemoattractant for neutrophils and help them to stick to the endothelial cells for migration. They also stimulate white cell phagocytosis and the production of inflammatory lipid prostaglandin E2 (PGE2). NSAIDs’ ability to interfere with the production of prostaglandin during the inflammatory cascade is the major mechanism cited for the anti-inflammatory success of these medications [Figure 1].[112]

Spreading a medication on your skin is not the same thing as swallowing it. Because Voltaren Gel is applied to the skin, dramatically less medication reaches the bloodstream — only a tiny fraction of what you would get from oral usage.1516 It is safe to assume that cardiovascular risks of moderate topical use are negligible compared to oral diclofenac, because so much less medication is actually getting into general circulation, and that is what the evidence now shows.17 Multiple studies have concluded that topical NSAIDs are both effective and safe.181920
Since herbal therapies for pain management have yet to be thoroughly studied, be careful when embarking on this treatment path. Regardless of the herb you try, remember that they're not benign. Research into their safety and efficacy is still limited, and the government doesn't regulate herbal products for quality. The best course is to talk to a health-care professional before testing out a herbal remedy.
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