While some clients receive massage therapy because they appreciate benefits such as reduced stress and tension, better sleep and a clearer mind, others choose massage because they’re trying to ease pain naturally. According to research published in The Journal of Pain in 2015, chronic pain affects more than 126 million adults in the U.S.
What does this mean to you as a massage therapist? First and foremost, it means you likely have many clients who are suffering from acute or chronic pain—so you must understand which topical ingredients can offer your clients extra pain relief, and why.
Scott Schreiber, D.C., a chiropractor, acupuncturist and nutritionist in Newark, Delaware, said there are a number of different ingredients to consider when it comes to pain-relieving topicals.
One of the most common ingredients in pain-relief topicals is menthol.
“When applied, a cooling sensation is felt on the skin. This cooling sensation disrupts the pain signals being sent to the brain, known as the pain-gate theory, as well as distracting you from the pain sensation,” Schreiber said. “More recently, there has been some research that shows that menthol stimulates cold receptors, inducing analgesia,” he added.
Another ingredient is methyl salicylate, a compound that smells like wintergreen. Part of what makes this ingredient so beneficial, said Schreiber, is that it’s “part of a complex system plants use when fending off disease. It is part of the salicylic acid family, commonly known as aspirin, which has anti-inflammatory and analgesic properties.” This makes methyl salicylate a good choice for clients, provided they don’t have an aspirin allergy, he added.
A third pain-relieving ingredient is capsaicin, the compound responsible for the heat in peppers. “When applied to the body, the characteristic burning sensation is decreasing the body’s supply of substance P,” said Schreiber, “shutting down the pain pathways.” (Substance P is a neurotransmitter, a chemical involved in the transmission of pain signals to the central nervous system.)
Schreiber warned that some people don’t care for this burning sensation, but also that this reaction may be less intense in combination products, potentially making them a better choice.
If there is inflammation present, Schreiber suggested using a topical containing Arnica montana, an ingredient derived from a daisy-like plant. “When used as a topical, the herbal variety is anti-inflammatory and works as described,” he said. “The homeopathic product … has yet to be proven effective.”
“Multiple formulations of pain management creams help muscle pain,” said Amy Baxter, M.D., CEO of MMJ Labs LLC, a company that studies topical anesthetics and the effects of massage.
“The primary difference in efficacy is absorption and duration of effect,” she added. “Often these two are inversely related. The easier it is for something to be absorbed, the faster it is cleared away from the muscle.”
Temperature matters too, said Baxter. “While the pain nerve that transmits injury pain can be blocked by cold and motion (gate control), when a muscle is spasmed, heat can relax it. After spasm is resolved, cold is better for decreasing the inflammation that comes from damage, but cold can decrease absorption of analgesic creams.”
How to Incorporate These Topicals into Your Practice
Raisy Gittler, L.M.T., C.H.T.P., has a list of clientele, primarily women, who are seeking relief from pain.
“The younger ones are nursing moms whose shoulders are tight from leaning over the babies, or sore from lifting, pushing, playing and other day-to-day activities,” said Gittler. “My older clients generally have more chronic issues like fibromyalgia pain, plantar fasciitis, et cetera,” she added, advising that she also treats a lot of clients with neck pain, which she said she believes originates from cellphone and computer use.
“In treating clients who are experiencing pain, I am prudent in using pain-relieving topicals that are temporary and numbing,” Gittler said. “I use them sparingly because I want client feedback while working with them.”
“However, I do find topicals are very helpful when applied to the source of the pain, the trigger points. By calming the trigger point, the client can then relax, allowing me to manipulate the tissue in a more effective manner, followed by topical essential oils which can help loosen the tissues, allowing for better blood flow and pain relief.”
Considerations When Using Topicals to Ease Pain
As with any type of lubricant, “Pain-relieving topicals should not be applied if the user has an allergy to any of the product’s ingredients,” said Lillie Rosenthal, D.O., who practices in New York, New York. And also true of any lubricant, topical pain relievers should also never be used on open wounds.
When using products with menthol, Schreiber said massage therapists should be careful to not get them near a client’s eyes.
Additionally, “Counterirritants will not provide relief to those with deep muscle pain,” said Rosenthal, who also said that some topicals’ strong, medicinal odor may be irritating to certain clients.
It’s also important to know that salicylates can adversely react with some medications, said Rosenthal. One of the most notable reactions is with blood thinners.
Capsaicin, specifically, “often has a delayed action, so it may not be a good choice for someone seeking fast pain relief,” said Rosenthal. “Topical capsaicin can also burn or irritate the eyes and mouth, if it comes in contact with these areas,” she added. “Thus, it is essential to wash hands thoroughly after using capsaicin.”
Extend the Benefits
By adding a pain-relieving topical to a session, you help ease pain naturally and more quickly, enhance the client’s experience, and prolong the benefits of your massage.
About the Author
Christina DeBusk is a freelance writer who specializes in health and wellness and business marketing. She currently writes for ChiroNexus as well as other health-related publications. She can be contacted through christinamdebusk.com. She has written several articles for massagemag.com, including “What Can Cruelty-Free Products Do for Animals—and Your Practice?”