Musculoskeletal Pain

Two top medical groups issued new guidelines for treating Musculoskeletal Pain.

Former Chief Medical correspondent Dr. Bob Arnot explains those guidelines.

The weekend but they do less than a bet as temperature start to drop about c1 3 doctor groups with more than 300,000 physician members have issued new guidelines for treating musculoskeletal pain that accounts for 65 million healthcare visits each and every year.

Dr. bob arnot is here to explain.

Welcome to the show, doctor.

Dr. bob arnot: thank you so much, lisa.

Lisa: now let's get right to it.

Why are these new guidelines such a big change in how we treat pain?

Dr. bob arnot: well, for a century we've reached for a bottle whenever we have pain.

So this is a tectonic shift.

It's a sea change in how we treat pain and it'd be hard for customers to make the adjustment because they're so used to just picking up a pill and taking a pill.

But with all of the terrible side effects, even with an ibuprofen, the cdc reports 15,500 deaths a year, acetaminophen 450 deaths a year, the leading reason people have to have a liver trans in most years.

So if there's one single sort of phrase for your viewers to remember it is, think topical first.

If you have mild to moderate pain and you can touch it, think topicals first.

Now, you mentioned these amazing organizations, the american college of physicians, the american academy of family physicians, 300,000 strong.

And you know, they looked at this for a very interesting reason, and that is the risk of opioid abuse.

They took 13 million us insurance claims, mcmaster researchers... it's a great university... and they found that for you and i going to an emergency room, if we're given an opioid, there's a 6% chance we're going to keep on taking that with a risk of addiction.

If you're at high risk, there's a 27% chance, a one in four chance you're going to continue taking that medication over time, with all the risks that go along with it.

So not only are the topicals safe, safe, safe, and the most effective.

It's very interesting is that when these researchers did this study, their conclusion was that the topical pain formulations were the most effective.

And of course, they have the fewer side effects and the least risk, no risk of opioid abuse.

Lisa: so why is it so important for americans to rethink pain management?

You had mentioned the opioid abuse.

Is that the only reason?

Dr. bob arnot: well, the other reason is because you do have these terrible side effects with the topical pain formulations.

They seem so safe, but when you look at the national statistics, there's real risks there.

And what's so great about this is this is a fantastic balance of safety first with efficacy versus the oral.

And the other reason which i think is so interesting is that they are the most effective.

According to these researchers, this is the most effective treatment, as well.

Lisa: okay.

And let's talk about that.

How effective are topical therapies when it comes to treating pain?

And do you have any examples of that?

Dr. bob arnot: sure.

So they're highly effective.

And of course, you look at why.

You take an oral medication, it's going go to lung, liver, brain, all over your body, whereas a topical formulation, it's going to go right in there.

The nociceptors, the pain receptors, just a millimeter or so underneath the surface.

So it's right there.

One example at your local drug store is a salonpas patch, large.

It's in a green box.

It's fda approved.

I used it for the classic world championships for standup paddling, a seven hour race over boiling waters and big winds.

Stayed on for the whole seven hours.

And what's interesting is this particular company, it's a japanese pharmaceutical company, over 170 years old.

And do you know that there's about 2,000 years worth of experience with topical medications in the far east.

So tremendous tradition, real technology here.

And this is next generation therapy, topical therapy.

Think topicals first.

Lisa: and can you discuss the differences between the topical pain relievers and the oral pain relievers?

Dr. bob arnot: so sure.

If i were to take an oral pain reliever, it goes in through my stomach.

Could cause, if it's an ibuprofen, a stomach bleed or irritation.

Goes into my heart where it can increase the risk of a heart attack, brain and blood vessels where it could increase the risk of stroke.

And by the time it's made its all the way down to say my finger, if that's what's sore, just a little bit of that medication has gotten there.

Whereas if i take the same dosage of the topical medication, all of that medication is getting right to the site of the pain and right down and through to the nociceptor.

Now, it's very technical.

We call it the arachidonic acid pain pathway.

And this pathway is like a waterfall, like a cascade of all these different cytokines and chemicals and pain causing, inflammation causing substances.

And you're cutting that off using the main product here, which is an nsaid.

In this case with salonpas, it's methyl salicylate.

They also recommend menthol, and this has menthol in it, as well, which gives it a terrific aroma and helps it work better.

Lisa: gotcha.

And where can we go for more information?

Dr. bob arnot: so there's a great website.

I use it all the time and send patients there, and it's salonpas.us.

It's not dot com, but dot us, salonpas.us.

Lisa: well, doctor, thank you so much for being with us and for all the information.

We really appreciate it.

Dr. bob arnot: i appreciate