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.
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.
The first is that inflammation-lowering NSAIDs destroy your gut lining. Check the bottle of ibuprofen or aspirin in your medicine cabinet. You’ll see it right on the label: “NSAIDs such as ibuprofen may cause ulcers, bleeding, or holes in the stomach and/or intestine.”[1] Long-term low-dose aspirin use is particularly likely to cause ulcers and tear holes in your intestine.[2]
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