One concern about the use of products like Voltaren is that several conditions are less inflammatory in nature than they feel like. Patients usually assume that the “burning” pain of repetitive strain injuries like tendinitis is caused by inflammation, but in fact classic inflammation is largely absent, especially after initial flare-ups have died down (but pain is still carrying on). While it is possible, even likely, that tendinitis is still inflamed in some sense, it’s doubtful that they are inflamed in a way that NSAIDs are actually good for. The biochemistry of cranky tendons is rather complex and largely unknown. There’s probably some overlap between the biology of acute, classic inflammation and the subtler biology of chronic tendinitis, but no one really knows. So the value of Voltaren for tendinitis is unclear.
In addition to the other methods and strategies discussed throughout my book, I recommend taking natural remedies that reduce pain and inflammation, protect joint health and promote healing without side effects. Below I offer an overview of 20 different supplements formulas or ingredients often found within such formulations. Read each, keeping in mind your specific condition and how some may be more effective for you than others.
The use of fish oil (in the form of cod liver oil), an omega-3 EFA, for the treatment of muscular, skeletal, and discogenic diseases, can be traced back to the late 18th century as detailed by Curtis et al.,[24,25] Unfortunately, because of the rapid onset of rancidity of this polyunsaturated oil when exposed to air, and hence its disconcerting odor, cod liver oil fell out of favor. With improved extraction techniques, such as using a protective nitrogen blanket and enhanced oxygen-free encapsulation methods, there is less chance of oxidation during the manufacturing process. The therapeutic benefits of fish oil can now be realized without the regurgitation and odor of previous products caused by peroxides and rancid tasting fish oil.[14]
Over-the-counter (OTC) pain medications are fairly safe and somewhat effective in moderation and work in different ways, so do experiment cautiously. There are four kinds: acetaminophen/paracetamol (Tylenol, Panadol), plus three non-steroidal anti-inflammatories (NSAIDs): aspirin (Bayer, Bufferin), ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn). Don’t take any of them chronically — risks go up over time, and they can even backfire and cause nasty rebound headaches. They are all probably equally effective for acute injuries (Hung), but benefits vary with people and issues (chronic pain, headache, arthritis, etc). Acetaminophen is good for both fever and pain, and is one of the safest of all drugs at recommended dosages, but it may not work well for musculoskeletal pain (at all?) and overdose can badly hurt livers. The NSAIDs all reduce inflammation as well as pain and fever, but at any dose they can cause heart attacks and strokes and they are “gut burners” (they irritate the GI tract, even taken with food). Aspirin may be best for joint and muscle pain, but it’s the most gut-burning of them all. Voltaren® Gel Review is an ointment NSAID, effective for superficial pain and safer (Derry). Athletes, puh-lease don’t take “Vitamin I” to prevent soreness — it doesn’t work!
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.
Omega 3 fatty acid supplements are one of the most powerful ways to reduce oxidative stress and inflammation which are the underlying markers we see on labs with individuals who are suffering with chronic pain.   Omega 3’s help provide better cell membrane receptor activity and suppress genetic transcription factors associated with inflammation and pain.
For centuries, natural anti-inflammatory compounds have been used to mediate the inflammatory process and often with fewer side effects. We have briefly reviewed several of the most commonly used plant- and animal-derived natural compounds that may possess similar effectiveness in treating the inflammatory reaction seen in both chronic and sub-acute pain syndromes encountered in a typical neurosurgical practice. Ongoing experiments and clinical trials should be continued to guide and provide their scientifically based effectiveness to reduce inflammation and promote wellness.
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In a 2011 research review published in the British Journal of Anaesthesia, investigators looked at the available research on the use of topically applied capsaicin in the treatment of several types of chronic pain. This included two clinical trials examining back pain, both of which found that capsaicin helped reduce low back pain without causing notable side effects.
Lower back pain can be mild to very severe depending on its underlying causes, how long it’s been left untreated and the state of someone’s overall health. The University of Maryland Medical Center states that several important risk factors for lower back problems include family history of back pain, smoking or using tobacco, being overweight or obese, being female, being anxious or depressed, and either doing too much physical work or living a sedentary lifestyle.
Omega-3 EFA, found in fish oil, can directly reduce the degenerative enzymes, aggrecanase and matrix metalloproteinase, as well as IL-1, TNF-α, and COX-2, to reduce the inflammation in synovial cartilage. A recent study of 250 patients with cervical and lumbar disc disease, who were taking NSAIDs, revealed that 59% could substitute fish oil supplements as a natural anti-inflammatory agent for the NSAIDs.[71] The recommended dosage is a total of 1.5–5g of EPA and DHA per day, taken with meals.
Turmeric root contains just 2% to 5% curcumin, so when reaching for a supplement, be sure you’re buying curcumin, not powered turmeric root. Curcumin is not easily absorbed by the digestive tract, so choose high-potency curcuminoids and combine with oil, since curcumin is fat-soluble. Black pepper extract (piperine), though not Bulletproof, has also been shown to increase curcumin’s bioavailability by 2000%.[13] However, some newer, high-tech curcuminoid formulas have been shown to offer the same potency levels without the use of piperine.[14]
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