Ointment for pain in the joints: choose the right

Ointment for pain in the joints is rightfully considered the most popular and very effective means of local, that is, external impact on the pain syndrome.

Today, the assortment of such drugs is extremely extensive, so their choice should be approached with an understanding of the causes of existing pathologies: what ointment from pain in the knee joint to use when injuring it, and what ointment from pain in the shoulder joint is used, say, for inflammatory changes in its synovial membranes chronic osteoarthritis), bursitis or traumatic arthritis.

To evaluate the merits of all the medicines of this pharmacological group within the framework of one review is rather difficult, so we will concentrate on what names of ointments for pain in the joints are most often voiced by doctors recommending these drugs to their patients and why.

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Indications for the use of ointments for pain in the joints

The main indications for the use of ointments for pain in joints include a wide range of diseases of the musculoskeletal system and the musculoskeletal system of various etiologies: traumatic, inflammatory or associated with a metabolic disorder affecting the joints.

Depending on the principle of therapeutic effect, anti-inflammatory ointments and local irritants are distinguished. Anti-inflammatory ointment for pain in the joints is used for such diseases as rheumatoid arthritis, deforming arthrosis, spondylitis, osteochondrosis, osteoarthritis and osteoarthritis; with radiculitis and inflammation of the surrounding joints of soft tissues (bursitis, tendovaginitis). Anti-pain agents of local action are also recommended for joint and muscle injuries, peripheral nerve lesions (neuralgia) and myalgia (muscle pain).

Ointments for joint pain are included in the complex systemic therapy of arthralgic syndrome, which accompanies certain infectious, endocrine, neurological and autoimmune diseases.

In many cases, it is most advisable to use nonsteroidal anti-inflammatory drugs (NSAIDs), which not only relieve pain in the joints, but also affect the inflammatory process that causes them. The form of release of these drugs - ointments, gels or creams in tubes. These include Diclofenac (Diklak-gel, Voltaren, etc.), Ibuprofen (Dip Rilif et al.), Ketonal (Fastum gel, etc.), Piroxicam (Finalgel), and others.

To get rid of the pain caused by bruising, dislocation or stretching, ointments of local irritating action can be used: Bengin (Bom-Benge), Vipralgon (Viprosal, Alvipsal, etc.), Gavkamen (Efkamon), Kapsikam (Espol, Finalgon).

Pharmacodynamics of ointments for pain in joints

The main mechanism of anti-inflammatory and analgesic action of Diclofenac (other trade names - Diclac gel, Diclofenacol, Diclouran, Voltaren emulgel, Orthofen, Orthoflex) triggers the active substance diclofenac (sodium salt of phenylacetic acid). It slows down the process of biosynthesis of local mediators of prostaglandins, which, at the site of damage to cell membranes during inflammation, provide the body's response - somatic pain.

The active substance of ointment for joint pain Ibuprofen (other trade names - Dip Reilif, Dolgit, Ibalgin, Ibutop) is a nonsteroidal anti-inflammatory drug ibuprofen. In the ointment Piroksikam (synonyms Piroksikam-Verte, Finalagel) the main component - piroxicam. And the Ketonal drug (synonyms: Valusal, Fastum gel, Ketonal Forte, Bystrumgel, Ultrafastin) is an active substance derived from propionic acid ketoprofen, also belonging to the group of non-steroidal anti-inflammatory drugs. The pharmacodynamics of all these ointments is similar to Diclofenac: they are inhibitors of prostaglandins.

Ointments for pain in the joints, which are local irritating, pharmacological action provides:

• Bengin (Bom-Benge) - menthol and methyl salicylate;
• Vipralgon (generics: Viprosal, Viprapin, Viprobel, Nizvysal, Alvipsal, etc.) - poison of gyurzy, camphor, acid salicylic and turpentine;
• Gavkamen (Flukoldeks, Efkamon) - carnation flower oil, camphor, menthol, eucalyptus oil;
• Apizarthron (analogues - Apifor, Ungapiven, Forapin) - bee venom, methyl salicylate;
• Capsicam (analogues - Finalgon, Betalgon, Espol) - extract of bitter peppers capsaicin.

The active substances of these drugs act reflexively, exciting the nerve endings of the skin receptors. As a result, the vessels expand, blood circulation at the site of inflammation or trauma increases (as evidenced by reddening of the skin), oxygen flow into the tissue increases. Due to this, the production of biogenic amines multiplies, which reduce pain sensitivity. A analgesic effect of capsaicin is explained by its powerful inhibitory effect on the neuropeptide, which transmits signals from the peripheral nerve endings to the brain.

Pharmacokinetics of ointments for pain in joints

Given the external way of using all gels, creams and ointments for pain in joints, the level of absorption of their active components is insignificant. Thus, for ointments based on NSAIDs (diclofenac, ibuprofen, ketoprofen, etc.), it does not exceed 6%, and the association with proteins is almost 100%. When these preparations are applied to the area of the affected joint, the main amount of active substances is concentrated in the synovial fluid that fills the joint cavity. And what is trapped in the plasma is excreted through the kidneys. Information on the metabolism of most irritating ointments, according to their official instructions, is missing. At best, it can be indicated that the drug does not have a systemic effect.

Dosing and Administration

All ointments for pain in the joints have one way of using - cutaneous. Ointments and gels based on diclofenac are rubbed into the skin over a painful place three times a day - 2-4 g of the preparation at a time. Single dose, prescribed to children 6-12 years, is 1.5-2 g (applied twice a day).

Gel Piroksikam (Finalagel) should be applied to the affected area, squeezing out a column of the drug not more than 1 cm long and rinsing it in a thin layer - three times during the day. Ointment Finalgon should be applied to the skin, rubbing the ointment with the applied applicator, 5 mm at a time - not more than three times a day. To increase the therapeutic effect, the place of application of the drug is recommended to be wrapped.

Ointments with camphor and turpentine rub 5-10 g once in 24 hours (with intense pain - twice a day). The duration of therapy is no more than 10 days. The same way of using and dosing for ointments based on poisons.

Since external application of ointments, creams and gels systemic absorption of their active components is minimal, an overdose of these medicines is considered impossible. Although Finalhelgel producers warn: when the dosage of the drug was significantly exceeded, in rare cases, headache, nausea, gastrointestinal disorders, and in isolated cases - functional renal failure were recorded.

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Contraindications to the use of ointments for pain in the joints

Among the contraindications to the use of Diclofenac and its analogs is the presence in the anamnesis of patients with bronchospasm, allergic rhinitis or skin reactions after using any non-steroidal anti-inflammatory drug or aspirin. With gastric ulcer, liver and kidney dysfunction, chronic heart failure and bronchial asthma, Diclofenac and all other ointments with NSAIDs are administered with caution. Children under 6 years (and Finalgel - children under 14 years), these ointments do not apply.

Absolute contraindications to the use of irritating ointments are increased sensitivity to their components and the presence of open wounds, dermatoses or even minor skin lesions at the site of application of the drug.

The use of ointments for joint pain during pregnancy is not recommended in most cases, as there is a lack of convincing clinical experience in their use in this situation. Ointment Diclofenac and its analogs during the third trimester of pregnancy and during lactation are not applied, and in the first two trimesters should be used with caution. Fastum gel can be used during pregnancy solely on the prescription of the treating doctor. And ointments, which contain ketoprofen, as well as bee or snake venom, are forbidden for pregnant and lactating women.

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Side effects of ointments for pain in joints

The use of ointments for joint pain on the basis of all the above non-steroidal anti-inflammatory drugs may be accompanied by undesirable side effects in the form of itching or burning, redness, or rash. It is possible that systemic side effects may occur: nausea, vomiting, headache, dizziness, edema, increased blood pressure and abnormalities of the gastrointestinal tract.

The use of Efkamon, Gavkamen or Flukoldeks, and also ointments based on snake or bee venom quite often causes allergic skin reactions at the place of their application.

Interactions of ointments from pain in joints with other drugs

Diclofenac and other NSAIDs can enhance the effect of drugs that cause increased sensitivity to ultraviolet radiation (sulfonamides, antibiotics, antifungal agents). Interactions with other drugs in clinical practice were not observed.

Ointment Ibuprofen (and its generics) reduces the effectiveness of diuretics (furosemide and hypothiazide) and some drugs to reduce blood pressure. And with the simultaneous administration of oral glucocorticoids, there is a danger of gastrointestinal bleeding.

Conditions for storing ointments for pain in joints

Optimum storage conditions for virtually all ointments for pain in the joints presented in this review is the temperature not higher than + 25 ° C. Preparations based on diclofenac should be stored at a temperature not higher than + 15 ° C. The shelf-life of medicinal products is indicated on their packaging.

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