NSAIDs have anti-inflammatory (reduce inflammation), analgesic (relieve pain) and antipyretic (lower temperature) effects. Although different NSAIDs have different structures, they all work by blocking cyclooxygenase (COX) enzymes. There are two main types of COX enzymes: COX-1 and COX-2. Both types produce prostaglandins; however, the main function of COX-1 enzymes is to produce baseline levels of prostaglandins that activate platelets and protect the lining of the gastrointestinal tract, whereas COX-2 enzymes are responsible for releasing prostaglandins after infection or injury. Prostaglandins have a number of different effects, one of which is to regulate inflammation. Most NSAIDs inhibit both enzymes, although a few are available that mainly inhibit COX-2. The pain-relieving and anti-inflammatory effects of NSAIDs are mainly due to inhibition of COX-2, and their unwanted side effects are largely due to inhibition of COX-1.

Whether it was brought on by arthritis, a structural or nerve problem, bending the wrong way, or lifting something a little too heavy, low back pain is frustrating as all get-out. But if you're struggling, know this: You're definitely not alone. Most people experience back pain at some point in their lives, and it's one of the most common reasons people book doctor's appointments and call out of work. It's also one of the leading causes of disability worldwide.


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.
I purchased this because it was less expensive than Penetrex and I'd thought I'd try it out.. Unfortunately, compared to Penetrex, at least for me, I do not feel that it is worth the savings. I'm using it for Plantar Fasciitis and Osteoarthritis in my knees. Although it does provide some pain relief, the duration is limited to a couple hours, whereas Penetrex lasts for up to half a day. However, SynthaFlex does offer a little more relief, albeit very temporarily, for my Osteoarthritis than Penetrex does. It is not nearly as effective for my Plantar Fasciitis pain. Ultimately, if I have to apply it many times throughout the day, it is not cost effective in comparison.
If you’re someone who experiences muscle and joint pain from time to time (or on a regular basis), you’ve probably tried quite a few options for pain relief. And you’re probably already using external pain relievers—the kind you apply directly to your skin for fast relief from sore muscles and joints. But have you thought of adding an external pain relief cream to the mix?
Nearly everyone suffers from some type of back pain at some point in their lives. But no matter when it appears or what may have caused it, back pain can be a real, well … pain to deal with. The good news? There are several simple things you can do to ease pain and keep your back in good condition. The following tips can help you get on the way toward feeling better.
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.
Authors of a 2016 review published in Seminars in Arthritis & Rheumatism conclude, “Topical NSAIDs have a moderate effect on pain relief, with efficacy similar to that of oral NSAIDs, with the advantage of a better risk:benefit ratio.” However, A 2016 Cochrane review looked at 39 studies with 10,631 participants and found that topical diclofenac, “can provide good levels of pain relief in osteoarthritis, but only for about 10% more people than get this result with topical placebo.”
Ginger is in the same family of anti-inflammatory spices as turmeric. While they share similar benefits, ginger is well known for its ability to relieve nausea associated with pregnancy and cancer treatments. It can also relieve pain in the same category as NSAIDs, making it another effective alternative to over-the-counter medications that have unpleasant side effects. (18)
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.
Zeng C, Wei J, Persson MS, et al. Relative efficacy and safety of topical non-steroidal anti-inflammatory drugs for osteoarthritis: a systematic review and network meta-analysis of randomised controlled trials and observational studies. Br J Sports Med. 2018 Feb. PubMed #29436380. “Topical NSAIDs were effective and safe for OA. Diclofenac patches may be the most effective topical NSAID for pain relief. No serious gastrointestinal and renal AEs were observed in trials or the general population.” BACK TO TEXT
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. 
I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine.org for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.

A type of enzyme extracted from pineapple stems, bromelain reduces levels of prostaglandins, which are hormones that induce inflammation. Bromelain may benefit people with arthritis and conditions associated with musculoskeletal tension (such as TMJ syndrome), as well as those suffering trauma-related inflammation. What's more, the enzyme may promote healing in muscles and connective tissues.
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