Arthritis Rubs with Capsaicin Make a Comeback: Advil Targeted Relief

Chronic pain has a devastating impact on your quality of life. Often, though, the medicines people swallow to relieve pain can trigger dangerous side effects over the long term. NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil) or naproxen (Aleve) may cause stomach ulcers, high blood pressure, heart attacks, strokes, kidney damage and atrial fibrillation. That’s why there is renewed interest in topical pain relievers. One old-fashioned ingredient, capsaicin, is making a comeback. So are some other ingredients your grandparents might have found familiar: camphor, menthol and methyl salicylate.

Capsaicin Ointment: A Time-Honored Ingredient:

Americans have been using topical arthritis medicines for more than a century. Sloan’s Liniment, for example, was originally developed in the 19^th century by harness maker and self-taught veterinarian, Andrew Sloan. It was intended for use on horses to ease their muscle pain.

Andrew’s son Earl later developed a thriving business selling Sloan’s liniment to people with arthritis, back pain, sore knees, rheumatism, lumbago, strains and sprains. He advertised it as “good for man and beast.”

The main ingredient in Sloan’s Liniment was capsaicin (the essence of hot chili peppers). It also contained menthol, methyl salicylate, camphor and oil of turpentine. It became extremely popular and profitable.

Many other old-fashioned topical arthritis remedies made use of one or more of those ingredients, too. They included Bengay, Mentholatum Ointment, Tiger Balm and Vicks VapoRub.

Advil Targeted Relief: A Modern Brand with Old-Fashioned Ingredients:

Fast forward to the 21^st century. Advil (ibuprofen) is an extremely popular over-the-counter oral pain reliever. This nonsteroidal anti-inflammatory drug (NSAID) became available without a prescription in 1984. Prior to that, ibuprofen was available only by prescription. Doctors often prescribed it under the brand name Motrin. OTC Motrin IB came out later.

Early last year, the maker of Advil took advantage of its brand name recognition. The company brought out a topical pain reliever called Advil Targeted Relief.

This pain-relieving cream looks ultra-modern and high tech. It comes with a fancy applicator cap. The ingredients, however, would have sounded quite familiar to the liniment makers of the 19^th and 20^th centuries: camphor, capsaicin, menthol and methyl salicylate. What was old is new again.

Discovering How Capsaicin Ointment WORKS!

Scientists believe that capsaicin ointment works by depleting substance P from the nerves of the skin. It may also affect transient receptor potential (TRP) channels on those nerves. Both TRPA1 and TRPV1, which respond to capsaicin, contribute to joint pain in arthritis and gout (Pharmaceuticals, Oct. 15, 2018).

You may not be surprised to learn that methyl salicylate also affects TRPV1 (Molecular Pharmacology, Feb. 2009). Both menthol and camphor, on the other hand, activate TRPM8, which affords a cooling sensation on the skin along with pain relief (Chemical Senses, Sept. 2013). We fear that many “modern” healthcare professionals are unaware of the science supporting these old-fashioned arthritis rubs.

Readers Share Stories About Topical Arthritis Remedies Containing Capsaicin Ointment:

A reader with knee arthritis shared that she uses a topical pain reliever containing camphor, capsaicin, menthol and methyl salicylate.

She reported that this combination is:

“very effective. I have found that I do not need to take Advil or any other oral pain drugs.”

Don’t Make Capsaicin Paste at Home:

Q. I have peripheral neuropathy that causes tingling and burning pain. I’ve heard that capsaicin from hot peppers can be used to treat neuropathy. Would grinding up habanero peppers and applying the paste to my feet counteract the numbness?

A. We would discourage this approach. You might harm yourself. Habanero peppers are extremely hot and could negatively affect your lungs or skin.

You can buy OTC capsaicin creams in most pharmacies or health food stores. They generally contain low-dose (0.1% or lower) capsaicin, though some are a bit stronger. If you apply them repeatedly, they can alleviate neuropathy (Biomedicine & Pharmacotherapy, Sep. 2022).

Qutenza , a prescription-strength capsaicin product (8%), is available from physicians. It requires administration by health care professionals in a well-ventilated treatment area. Read to the bottom of this post for more information on this prescription option for pain that has not responded to other treatments.

Old-Fashioned Liniment Earns Fans:

Q. I have suffered from bad knee pain for years. My doctor did a series of gel shots into my knees that helped. But my right knee continued to give me significant pain.

I read that capsaicin could be helpful, so I bought Sloan’s Liniment. It contains capsaicin (the active ingredient in chili peppers). Inactive ingredients include turpentine oil and methyl salicylate.

I don rubber gloves and soak a cotton ball with it, then rub it in for about two minutes. It is like a miracle drug! Hard to believe how much it helps.

What Is Sloan’s Liniment?

A. As described at the beginning of this article, Sloan’s Liniment dates back to the 19th century. Earl Sawyer Sloan made harnesses for horses. He also sold a concoction his father created to treat joint pain in work horses.

The liniment became extremely successful. Earl Sloan sold his business over 100 years ago for $1 million to the company that made Listerine, W. R. Warner & Co., which later became Warner-Lambert, the pharmaceutical manufacturer.

The FDA has approved capsaicin for the topical treatment of pain from arthritis, backache, strains and sprains. It stings when first applied, which can deter some folks from using it.

This old-fashioned remedy works in part by depleting something called substance P. Because this compound is important for pain perception, reducing it through repeated applications of capsaicin can ease inflammation and pain.

We are not so sure that methyl salicylate should be considered an inactive ingredient. It too is used topically to soothe sore muscles. A real-world study conducted in China found a compound methyl salicylate liniment safe and effective (Frontiers in Pharmacology, Oct. 21, 2022).

To learn about other natural approaches, from boswellia and bromelain to ashwagandha and turmeric, you may find our eGuide to Alternatives for Arthritis helpful. It can be found under the Health eGuides tab.

Using Capsaicin Ointment Carefully:

Q. For several decades or more, I have found capsaicin ointment to be very effective when other remedies for pain are inadequate. It eliminated the discomfort I experienced after vein removal from my calf. It gives long lasting relief from peripheral neuropathy in my feet and the unbearable itch my wife got months after a severe case of shingles.

We do have to be careful not to get the ointment in the eyes or on other sensitive areas. Also, we don’t expose treated areas to sun exposure because it produces an intense burning sensation. I apply the ointment with a foam brush or rubber gloves to keep it where it belongs.

A. You are smart to use a brush or gloves to apply this ointment. That reduces the chance you will get some in your eyes, nose, mouth or another sensitive spot.

What Is Capsaicin?

Capsaicin is the compound that makes chili peppers hot. Repeated application to the skin depletes substance P from the sensory nerves, allowing temporary relief from pain. This is apparently because capsaicin activates the transient receptor potential channel vanilloid 1 (TRPV1) (Pharmacology & Therapeutics, April 2021).

Because of this action, scientists have been trying to find a way to improve absorption through the skin for treating diabetic neuropathy (Advanced Pharmaceutical Bulletin, Aug. 2022). As you have noted, though, available capsaicin ointments can help ease pain.

The main side effect is the burning sensation when it is first applied. This fades with repeated applications.

Hot Pepper Rub for Arthritis:

Q. I have arthritis in several joints, especially my wrists and fingers. A number of years ago, I began applying a rub that contains capsaicin, the heat from hot peppers. I find it very effective if used daily. I have also added turmeric to my regimen. That offers additional pain relief.

A. Capsaicin, the compound that gives hot peppers their zip, has long been used in arthritis liniments such as BenGay, Heet or Sloan’s liniment. It is also available in gel or cream form. You may have seen Capzasin or Zostrix-HP.

Capsaicin Ointment Against Nerve Pain:

Zostrix was developed to treat the nerve pain that may linger after a shingles rash clears. If you apply a capsaicin product every day or several times daily, it can help ease arthritis pain (Progress in Drug Research, 2014). Some warnings, though. Many people find that such capsaicin ointments are just too uncomfortable for their delicate skin.

You might want to use disposable gloves to apply your rub. Getting even a tiny amount in your eyes, nose or other delicate tissues could be extremely uncomfortable.

Turmeric to Fight Inflammation:

Turmeric, the yellow spice in curry, has anti-inflammatory activity. You can learn more about it in our eGuide to Alternatives for Arthritis. This online resource covers a number of foods, medications and supplements that can help ease arthritis pain in hands and other joints.

Many years ago, we heard from this reader, whose doctor recommended capsaicin ointment.

VA Doctor Recommended Capsicum:

Q. My primary care doctor prescribed Cymbalta for neuropathy, a very painful burning sensation in three of my toes. It seemed to work, but it is expensive.

The doctor I saw at the VA recommended capsicum since Cymbalta is not on their list.

The capsicum really works. In fact, I can go as long as two months between a dosing series. One toe is completely healed, and the others are much better.

A. Capsicum is the technical name for peppers, including bell peppers as well as hot peppers. Capsaicin, the spicy essence of chili peppers, has been used to treat peripheral neuropathy, including the nerve pain that may linger after an outbreak of shingles.

Capsaicin ointment or cream must be applied repeatedly to deplete the nerve endings of something called substance P. At that point, they are less able to transmit pain sensations.

Be careful not to get the cream in your eyes or nose, as that can be extremely painful. Some people may develop an allergic reaction to capsaicin.

What About Prescription-Strength Capsaicin?

Q. You wrote about high-dose topical capsaicin (8%) for diabetic neuropathy. Maybe you are unaware of this, but no drugstore I have found carries capsaicin at any dose higher than 1%. I don’t know where you found this high-dose 8% stuff. Maybe it does not even exist.

A. Capsaicin is the hot essence of chili peppers. You are absolutely correct that over-the-counter capsaicin ointments and creams are usually less than 1% concentration. They are available as rubs for treating arthritis, muscle, joint or back pain.

The FDA has approved Qutenza (8% capsaicin) as an in-office prescription treatment for diabetic nerve pain of the feet and post-shingles nerve pain. It can only be applied by a healthcare professional in a well-ventilated area. This is definitely NOT a do-it-yourself approach.

Because this high-potency topical system can be quite painful, doctors often use a local anesthetic on the skin before applying it. The Qutenza system is extremely expensive, but we assure you that it does exist.

Confusion Over Topical Arthritis Rubs:

Some readers may find the latest topical arthritis treatments confusing, however. Voltaren Arthritis Pain Gel, which has been available for nearly two decades, contains a nonsteroidal anti-inflammatory drug called diclofenac. This NSAID is also found in oral prescription pain relievers but not in OTC pills.

Aleve is a very popular OTC oral NSAID. The active ingredient is naproxen. The manufacturer appears poised to introduce its own topical gel under the name Aleve Arthritis Pain Gel. Instead of naproxen, though, it contains diclofenac.

It would be easy for people to get all these different pain products mixed up. Just as the ingredients differ, so do the mechanisms of action. Precautions and side effects vary substantially from one product to the next, too.

Just because the brand seems familiar, don’t assume you know what is in the tube. Read the label and ask your pharmacist if the pain reliever you are purchasing is appropriate for your condition. To recap:

• Voltaren Arthritis Pain Gel contains diclofenac
• Voltaren prescription oral medicine contains diclofenac
• Aleve Arthritis Pain Gel contains diclofenac
• Aleve pills contain naproxen
•  Advil pills contain ibuprofen
• Advil Targeted Relief cream contains capsaicin, camphor, menthol, methylsalicylate

Should you wish to learn more about a variety of ways to treat arthritis, you may find our eGuide to Alternatives for Arthritis helpful. It can be found under the Health eGuides tab.