The main advantage of topical NSAIDs is the reduced exposure of the rest of the body to the product, which reduces the side effect profile. Given the toxicity of NSAIDs is related in part to the dose, it follows that topical treatments should have a better toxicity profile. Consequently, the cardiovascular risks of topical diclofenac, even in those with a high baseline risk of disease, should be negligible with the topical forms.
My personal preference is regenerative injection therapy (RIT). This is a non-operative, therapeutic approach to pain reduction that involves multiple small injections into a joint to encourage the body to initiate healing methods. Through the process of concentrating and injecting specific substances, such as prolo, PRP, or stem cells at the site of injury, the process of regeneration and remodeling is facilitated and a robust healing response is achieved. 
The Boswellia species are trees located in India, Ethiopia, Somalia, and the Arabian Peninsula, and they produce a gum resin called olibanum, better known in the western world as frankincense. This resin possesses anti-inflammatory, anti-arthritic, and analgesic properties. Boswellia can inhibit the leukotriene biosynthesis in neutrophilic granulocytes by inhibiting 5-LOX, thus affecting various inflammatory diseases that are perpetuated by leukotrienes.[95] Clinically, the substance is used in the treatment of degenerative and inflammatory joint disorders. It reduces the total white blood cell count in joint fluid, and it also inhibits leukocyte elastase, which is released in rheumatoid arthritis. In one recent study, a statistically significant improvement in arthritis of the knee was shown after 8 weeks of treatment with 333 mg B. serrata extract taken three times a day. The treatment improved function, but radiographically there was no change in the affected joints.[62]
I have pain in booth knees from arthritis. I have used this cream for over a year. All the other pain relievers I have used, don't come close to Topricin for quick and long lasting pain relief. I use it every night and sleep like a baby. I would recommend this product to anyone that needs fast and lasting relief from pain. To me this is a God sent.
“I recently started using Relief in my practice after being introduced to the product by a friend. My patients tell me they prefer Relief to the other analgesic gel because Relief works better, lasts longer, and there is no stickiness or unpleasant scent after using the cream. In addition to the patient response, I use Relief in my office because Corganics provides a high quality product with great customer service. Relief has been a great addition to my practice.” *
The exhibited pain cream of Penetrex brand comprises an evolved pain-relieving mechanism, which in effect is crafted by availing the highly effective ingredients of Cetyl Myristoleate or CMO and Methylsulfonylmethane or MSM. Whereas the first one enacts over the ground cause of all muscular and joint aches that is inflammation, the second one works over the physiological cells and fortifies them to fight pains. Other serviceable ingredients in the formulary include Arnica, Vitamin B6 and Choline. The pain cream is non-sticky and stain-free and vowed to gratis steroids and drugs. It is especially famous for dodging aches over knee, arm, calf, hip and wrist. The parent brand vends it in a 2oz volume pot.
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.
Capsaicin produces highly selective regional anesthesia by causing degeneration of capsaicin-sensitive nociceptive nerve endings which can produce significant and long-lasting increases in nociceptive thresholds. Capsaicin potently activates transient receptor potential vanilloid 1, which is a main receptor underlying nociception. It also inhibits NF-kB, thus producing an anti-inflammatory effect. Capsaicin can cause a burning sensation when it comes in contact with human flesh, and also in the digestive tract. This herb is rarely used alone but is generally mixed into other natural anti-arthritic preparations. There are topical capsaicin formulations now available to treat post-herpetic neuralgia. Other uses have been studied for peripheral neuropathies and chronic musculoskeletal pain.[15,20,35,55,58,88,110]
Resveratrol is a plant-based polyphenol molecule that is found in various concentrations of many different plant sources. The plant is called Japanese Knot weed or Polygonum cuspidatum, and the skins of red wine grapes are believe to have the most concentrated amounts of resveratrol. In plants, resveratrol is generally found in the plant skin and acts as a phytoalexin to protect the plant from infection, excessive UV radiation and aide in general plant defense. Resveratrol has also been found to have significant anti-mutation, anti-inflammatory, antoxidant and DNA protective actions, when consumed by animals and humans.

How it works: When back muscles hurt, the pain is usually caused by inflamed tissue. Cold reduces the swelling and discomfort, says Jason Highsmith, a neurosurgeon in Charleston, South Carolina. As soon as you feel pain, apply cold several times a day, 10 minutes at a time, for about three days. A bag of frozen peas works, or try a cold pack, like an Ace Reusable Cold Compress ($10 at drugstores).


Foam roller exercises are a form of self-myofascial release that, while kind of mildly painful at times, actually gets out those nagging muscle knots while helping you fix muscle imbalances that lead to poor posture and related musculoskeletal pain. It’s also an emerging treatment to reduce your risk of developing delayed muscle onset soreness, a common exercise-related pain that keeps people out of the gym. (6)
tell your doctor if you have severe diarrhea or vomiting or think you may be dehydrated; if you drink or have a history of drinking large amounts of alcohol, and if you have or have ever had any of the conditions mentioned in the IMPORTANT WARNING section or asthma, especially if you have frequent stuffed or runny nose or nasal polyps (swelling of the lining of the nose); swelling of the hands, feet, ankles, or lower legs; heart failure; or kidney or liver disease.
Creams derived from natural products can also provide local relief for painful muscles in fibromyalgia. The best part is that topical treatments tend to be very well tolerated with few side effects. Arnica is an herb used since the 1500s to treat bruises, muscle pain, and inflammation. It is still used today as a natural treatment for muscle pain in many different topical remedies. One herbal homeopathic cream that I have found helpful is MyPainAway Fibro cream. It includes arnica to reduce muscle pain, echinacea to reduce inflammation, along with other herbs targeted to reduce nerve pain by improving microcirculation around pain-sensing nerves.

The active ingredients in fish oil, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), enhance the conversion of COX to prostaglandin E3. A natural anti-inflammatory agent, prostaglandin E3 competitively inhibits the effects of the arachidonic acid conversion to prostaglandin E2, a highly inflammatory substance. Prostaglandin E3 also inhibits the synthesis of TNF-α and IL-1b, both of which are inflammatory cytokines. The EPA and DHA can inhibit the 5-LOX pathway, which converts arachidonic acid to inflammatory leukotrienes, by competitive inhibition as well. When EPA and DHA are incorporated into articular cartridge chondrocyte cell membranes, there is a dose-dependent decrease in the expression and activity of the proteoglycan-degrading aggrecanase enzymes.[12,23–25,27,50,85]

in December 1998, celecoxib (Celebrex) was approved by the Food and Drug Administration (FDA) as the first selective COX-2 inhibitor for treatment of arthritis pain.[92,13,22] Rofecoxib (Vioxx) was approved several months later, followed by valdecoxib (Bextra).[92,28,67,79] These NSAIDs were designed to allow continued production of the gastrointestinally protective prostaglandins produced through the COX-1 enzyme system while blocking the COX-2 enzyme that produces the inflammatory prostaglandins.[34,45,51,89]
Meditation and mindfulness. Mindfulness meditation, which focuses on awareness of the present moment, can reduce the way we perceive pain. In one study, only four days of training led to a 40% reduction in pain rating and a 57% reduction in pain-unpleasantness.[14] This kind of meditation can help you to control back pain, fibromyalgia, and migraines. Read more about meditation and mindfulness for pain control here.
There is a large amount of natural products on the market with anti-inflammatory properties which contain arnica, such as sports massage creams combining arnica and other natural plant extracts (devil’s claw, calendula, St John’s wort and peppermint oil, among others, as well as PHYSIORELAX FORTE PLUS cream) for symptomatic relief of joint and muscle pain. However, we must be well informed about the quality and origin of the extracts used in any creams, gels and ointments purchased at pharmacies, herbal shops and specialised phytotherapy shops, so that we use the best quality product possible.
Although most cases of back pain are “uncomplicated” and should be able to heal with the treatments mentioned above, sometimes in severe cases other interventions are necessary. Speak to your doctor if you experience lower back pain that does not get better in a few days or weeks. If back pain starts suddenly, look out for other symptoms that may point to a more serious condition, such as a fever, chills, dizziness, numbness or unexplained weight loss.
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Side effects from topical medications include redness, itching, and other skin irritation. They are generally mild—and uncommon. The cause of skin irritation is often the material used to make the cream or gel, not the NSAID, says Dr. Joanne Borg-Stein, medical director of the Harvard-affiliated Spaulding-Wellesley Rehabilitation Center in Massachusetts. When that happens, it’s possible for a pharmacist to create a preparation with ingredients that are less irritating to your skin.

"Herbals or other nutraceuticals that may help in some way — as well as those which may not actually help — do almost universally have the potential to harm through unwanted side effects, allergic reactions, and undesirable interactions with other substances and medicines," says Sam Moon, MD, MPH, associate director of education at Duke Integrative Medicine, a division of Duke University Medical Center in Durham, N.C. "Relative safety must be very carefully balanced against likely effectiveness."
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