Pain relieving ointments for bruises

A bruise is a closed-type soft tissue injury without damage to the integrity of the skin; in the bruise area, there is always a reaction from the damaged muscle tissue, subcutaneous fat, and blood vessels. As a rule, the inflammatory process is short-lived, but provokes nociceptive pain, which can be relieved by pain-relieving ointments for bruises.

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Indications for use

The pain symptom caused by damage to the subcutaneous tissue, soft tissues, is most often associated with bruises of varying severity and is the first clinical sign that requires anesthesia. In the treatment of contusio (bruise), pain-relieving ointments containing analgesic or anti-inflammatory components are used, often in combination with each other.

The application of a multi-component ointment is aimed at solving the following problems:

• local anesthesia.
• reduction of soft tissue hypoxia.
• stabilization of blood circulation, microcirculation.
• anti-inflammatory action.
• activation of resorption – absorption of foci of subcutaneous hemorrhage.
• reduction of swelling.

Almost all pain-relieving ointments for bruises produced by the modern pharmaceutical industry have a complex effect; single-component external agents are rarely used at present, since a bruise is not only pain, but also local inflammation and a violation of the integrity of soft tissues.

Pain-relieving ointments for bruises, indications for use:

• Any injuries that do not violate the integrity of the skin.
• Contusions of soft tissues without gross damage to their structures (fascia rupture, tissue crushing, muscle rupture, muscle bleeding).
• Dislocation accompanied by damage to the subcutaneous tissue.
• Muscle stretching without tearing.
• Myalgia.

Ointments that can relieve pain from bruises are divided into three categories:

1. Anesthesia using local cooling (cooling ointments).
2. Anesthesia by means of local irritant action, warming ointments.
3. Anesthesia combined with anti-inflammatory action – anti-inflammatory ointments.

Indications for use are determined by the nature of the injury, which must either be "cooled" or relieved of inflammation and thereby relieve pain from the bruise. A remedy with a particular pharmacodynamic property is selected according to the injury.

Pharmacodynamics

Regulation of pain in bruises is based on stimulation of sensory nerve fibers of type A, which helps suppress the transmission of pain signals from tactile mechanoreceptors. In this case, there is a local lateral slowdown in transmission at the level of the spinal cord. A simple example as an argument is that even simple rubbing of the meta bruise, which is often done automatically, can reduce pain in the area of a slight bruise. In essence, the first pain relief occurs directly at the moment of rubbing in the pain-relieving ointment, and then the pharmacodynamics of the medicinal components, penetrating the pain zone transcutaneously, comes into effect.

Thus, the mechanism of action of external anesthetic agents is due to the suppression and inhibition of nerve conduction.

Types of pain relief using ointment form can be as follows:

• Terminal anesthesia.
• Infiltration anesthesia.

Terminal anesthesia (superficial) is the most commonly used method of pain relief for bruises, when there is a temporary block of nerve receptors. Infiltration can be used in case of extensive bruises, accompanied by sprains, dislocations. Anesthesia is achieved by gradual, layer-by-layer application of ointment, which is gradually absorbed into the deeper layers of soft tissues, the agent thus acts not only on the skin's superficial receptors, but also on the fibers of the peripheral nerves that conduct pain. Anesthetic ointments inhibit the transport of sodium and potassium ions by blocking the membrane channels of the nerves, which disrupts the conductivity of the nerve impulse. As a result, there is an effect of partial loss of sensitivity in the area of application of the ointment without loss of conductivity in the distal or proximal zone of the nerve fiber.

In addition, the pharmacodynamics of anesthetic external agents may be related to the specificity of the ointment components. The following medicinal substances are included in pain-relieving ointments for bruises:

• Methyl ester of salicylic acid or methyl salicylate (aspirin) - inhibits cyclooxygenase, which is considered the main enzyme in the synthesis of biologically active substances (prostaglandins) - the main molecules involved in the inflammatory process. Methyl salicylate inhibits synthesis, thereby reducing all inflammatory effects at the site of injury.
• Para-isobutylphenyl - ibuprofen, which is an arylcarboxylic acid derivative. Ibuprofen inhibits the cyclooxygenase pathway of prostaglandin binding.
• 3-benzoyl-alpha-methylbenzeneacetic acid – ketoprofen, which affects lipoxygenase, cyclooxygenase, thereby disrupting the metabolism of arachidonic acid – an inflammatory mediator.
• Diclofenac Na – diclofenac, which slows down, inhibits cyclooxygenase and the arachidonic transfer reaction.
• Para-chlorobenzoyl-indomethacin, also an inhibitor of the cyclooxygenase pathway of prostaglandin synthesis.

Pharmacokinetics

The pharmacokinetics of external anesthetics are determined by their composition. As a rule, simple two- or three-component ointments, when applied locally, are not able to penetrate the bloodstream and have a systemic effect on the body. Complex ointments, due to the active components included, can be partially absorbed into the blood, but this is typical for long-term treatment courses, which is not indicated for bruises. Even highly active external agents are quickly excreted from the body through the kidneys and liver, without causing significant side effects.

Overdose or prolonged, uncontrolled use of ointments containing ibuprofen may provoke accumulation of the active substance in the blood plasma, but in very small quantities. As a result of metabolism, the breakdown products of ibuprofen are excreted through the kidneys with urine.

Names of pain-relieving ointments for bruises

1. Ben-Gay is a combined external agent with anesthetic and warming effect.
2. Analgos is a locally irritating ointment containing propyl nicotinate, the product enhances microcirculation of blood flow, dilates blood vessels, and relieves pain.
3. Perkluzon (Clofezon.) is an ointment that has a local anesthetic effect and also an anti-inflammatory effect.
4. Nikoflex, a combined ointment that includes capsaicin (local irritant effect), ethyl nicotinate - anesthetic effect, as well as lavender essential oil, which enhances pain relief.
5. Lidochlor is a gel that stabilizes cell membranes and inhibits nerve conduction.
6. Balsam "Sanitas" containing methyl salicylate. The product has an analgesic and anti-inflammatory effect.
7. Voltaren Emulgel, a diclofenac-based product that can reduce inflammation and relieve pain in the area of the bruise.
8. Gevkamen is a menthol-based ointment that quickly relieves the first pain symptom and, due to the content of essential oils, is able to activate local blood microcirculation.
9. Deep Relief is an external remedy based on ibuprofen. First of all, the ointment quickly relieves the symptoms of inflammation in the subcutaneous tissue, thereby reducing the degree of pain.
10. Dolgit is an ointment based on a non-steroidal anti-inflammatory drug (ibuprofen). The product is quickly absorbed into the skin, relieving pain and inflammation in bruises.
11. Dolobene, a drug based on dimethyl sulfoxide, also contains heparin and dexpanthenol. The ointment reduces pain, swelling, and has an anticoagulant effect due to heparin.
12. Indovazin is an ointment based on intomethacin, with the inclusion of a certain amount of troxevasin. The product relieves pain, inflammation, swelling, improves blood supply to tissues, and reduces the likelihood of their hypoxia.
13. Ketonal (ketoprofen) is an anesthetic ointment with an anti-inflammatory effect.
14. Myoton, based on medicinal plant raw materials, warms up, causing short-term hyperemia, the ointment reduces pain symptoms and activates blood circulation in the area of the injury.
15. Kapilar is a cream that contains turpentine from pine resin, camphor and essential oils. The product is used for bruises and hematomas as an analgesic and circulation-stimulating ointment.

How to use pain-relieving ointments for bruises

External pain relief with a drug in a dispersion form is considered one of the safest and most effective methods of treating simple injuries. Transcutaneous anesthesia does not affect the condition of internal organs and systems, since most of the ointment remains in the upper layers of the skin. In addition, it is almost impossible to exceed the dose, excess ointment is very easy to remove from the injury site.

An external pain reliever is applied only to the area of the bruise, if the skin is damaged, it should be treated, and the ointment is applied only after the wound or scratch has healed. The method of application and doses of the ointment are indicated on the package, but it is usually recommended to lubricate the injury site within the boundaries of the painful focus. Before applying, the skin should be treated with any antiseptic, since the cleaned surface will promote better absorption of the external drug. Depending on the extent of the injury and its nature, as well as on what kind of ointment (warming or cooling), the method and doses may be different. Warming ointments are used twice a day for 2-3 days, the product is applied with light rubbing movements, the dose is determined by the boundaries of the bruise, the diameter of the lubricated focus should not exceed 15 centimeters for adult patients and 7 centimeters for children. The same rules apply to cooling agents. As a rule, the pain-relieving procedure does not require the application of a fixing bandage, occlusive fixation is needed only for extensive bruises accompanied by sprains or dislocations. The course of treatment with external anesthetics should not exceed 5 days, the therapeutic effect occurs after 5-10 minutes and does not last long - no more than an hour. However, you should not get carried away with pain-relieving ointments and use them more than 3 times a day, and you should not allow strong rubbing of the bruise site.

Using pain-relieving ointments for bruises during pregnancy

During pregnancy, caution should be exercised not only when using medications in tablet form, but also when using ointments, including ointments for bruises.

The use of painkillers for minor injuries during pregnancy should be supervised by the attending physician. Ointments containing the following components are not allowed:

• Methyl salicylates.
• Nonsteroidal anti-inflammatory drugs, ointments containing diclofenac, especially in the third trimester.
• Ointments containing snake or bee venom.
• Ointments with camphor or essential oils that can penetrate into the bloodstream and then into the placenta.
• Warming ointments that can cause disruption of the blood supply to the placenta and minor fetal hypoxia.

In general, pregnant women should not expose themselves to risks and allow bruises in principle, but if an injury does occur, treatment should be prescribed by the attending physician.

Contraindications for use

Despite the fact that pain-relieving ointments for bruises are generally safe, they are not considered universal and have contraindications for use. This is due to their multi-component composition, in addition, NSAIDs included in the composition are able to partially penetrate the bloodstream and provoke unwanted side effects in some groups of patients.

External pain relievers - contraindications for use:

1. History of allergies.
   • Allergy to nonsteroidal anti-inflammatory drugs.
   • Allergy to methyl salicylates.
   • Allergy to essential oils.
   • Allergy to bee products.
2. Damage to the skin - wound, cut, scratch.
3. Dermatitis.
4. Use with caution in acute kidney and liver diseases.
5. Relative contraindication: pregnancy and lactation.
6. Psoriasis, eczema.
7. Individual intolerance to the components of the ointment.
8. Children under 1.5-2 years of age.

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Side effects

As a rule, complications and side effects of external preparations for bruises are associated with improper use of ointments, or with their excessively frequent and abundant application. Very rarely, the following side effects may be observed with soft tissue contusions:

• Redness and hyperemia of the skin in the area of injury.
• Burning, itching.
• Allergic rash.
• Very rarely – an allergic reaction in the form of Quincke's edema.

If any atypical signs appear, or the condition worsens, stop using the ointment, treat the bruise and remove the ointment. If the ointment causes side effects in the form of a severe allergic reaction, desensitizing therapy is performed; if swelling, difficulty breathing, or decreased blood pressure develop, call an ambulance.

In general, anesthetic ointments used for bruises are safe, and their side effects are almost never encountered in medical practice.

Overdose

Bruises rarely cause severe and prolonged pain, so an overdose of pain-relieving ointments is unlikely. Given the pharmacodynamics and pharmacokinetics of any external agents, the ointment form is in principle not capable of a high degree of absorption. Such cases are possible only with excessive zeal of the injured person, who mistakenly believes that the more and more often he applies the ointment, the faster the pain symptom and the bruise that caused it will pass.

Very rarely, excessive application of anesthetic ointment can provoke a rash, itching, dizziness, headache, this is more likely to apply to products containing essential oils. If such symptoms appear, the ointment should be discontinued and replaced with a more gentle drug, possibly based on one active ingredient - an analgesic or NSAID.

Even more rarely, cases of internal use of the ointment are noted in medical practice, which quite naturally causes a negative response from the internal organs. There is no specific treatment or antidote for such situations, you should wash out the stomach or immediately seek medical help.

Interactions with other drugs

External agents in the form of ointments do not have the ability to be systemically absorbed, so their interaction with other drugs is permissible without the risk of any complications. However, it should be noted that pain-relieving ointments for bruises based on NSAIDs (non-steroidal anti-inflammatory drugs) can enhance the effect of oral administration of similar drugs in the form of tablets or injections. In such cases, a gastrotoxic and hepatotoxic effect is possible.

It is also worth paying attention to ointments with the inclusion of heparin, which enhance the effect of the tablet form of NSAIDs (analgesia), and also enhance the anticoagulant effect.

Interactions with other drugs in the form of external agents, such as essential oils with a cooling effect, only provide a quick anesthetic effect at the site of the injury. Such synergy can be provided by a ready-made product - a multi-component pain-relieving ointment. The regime of alternating lotions with essential oil and ointment applications takes a lot of time and is not as productive as using a ready-made medicine in the form of an anesthetic ointment.

In general, the ointment for bruises does not provoke complications, it combines well with other medications, in addition, anesthesia is used only for a few days, which ensures the relative safety of drug interactions.

How to store pain-relieving ointments for bruises?

The terms and methods of storing ointments are indicated on the factory packaging and correspond to the technical documentation. In general, any ointment should be stored in a dark, dry place, inaccessible to small children. The storage conditions for pain-relieving ointments are similar, they should be placed in a cabinet or a special box (first aid kit), it is undesirable to store the ointment on the table, especially with access to sunlight.

The temperature corresponding to the storage conditions of external anesthetic and anti-inflammatory agents should not exceed 15 degrees Celsius.

It is recommended to observe the storage conditions for external medicinal products according to the information on the packaging, since the influence of environmental factors - light, air, temperature changes, have an extremely adverse effect on the therapeutic properties of the ointment, reducing its activity. Light destroys the ointment base, it can delaminate, become heterogeneous. The Vaseline base loses its absorption properties at high temperatures (liquid sweats out). The ointment in suspension form also loses homogeneity at elevated room temperatures, its dispersed phases settle, sedimentation occurs. Air temperature affects gel forms of ointment - it dries out. Thus, in order to preserve the physicochemical properties of pain-relieving ointments, they should be stored according to the specified rules.

Best before date

Finished pharmaceutical products retain their pharmacological properties for 6-24 months depending on the composition. Ointments prepared extemporaneously are stored for no more than 10 days.

Pain-relieving ointments for bruises are used for no more than 3-5 days; if the pain symptom does not subside, you should consult a doctor and examine the site of the injury to determine its true cause and begin adequate treatment.