1. Biofreeze 101 Lynda Solien-Wolfe LMT And Bop Poirier 1

2. BIOFREEZE 101: Goals What is BIOFREEZE? A topical analgesic Why use a topical analgesic? What are the typical ingredients in topical analgesics? How do topical analgesics work? How do you apply Biofreeze? What are the contraindications of Biofreeze? 2

3. What is a topical analgesic? A topical analgesic is a product that is applied to the skin surface for the purpose of relieving soreness and pain in soft tissue and joints. 3

4. Why use a topical analgesic? Delivers targeted pain relief Low levels of systemic absorption Less risk for systemic toxicity Less risk for drug interaction Safer alternative to systemic medications

5. 5 The Pain Cycle

6. 6 Breaks the pain cycle

7. Benefits of using a topical analgesic Pain free movement Effective relief of sore muscles Painful joints Recovery from muscular strains and sprains

8. 8 What are the typical ingredients in topical analgesics? Key ingredients and quality vary by manufacturer Typical ingredients are – Menthol – Alcohol

9. How do topical analgesics work? 9 Two Mechanisms – Counter-irritation – Cryotherapy

10. 10 Counter-irritation Commonly known as the Gate Control Theory of Melzak & Wall (1965) Stimulates sensory receptors in the skin Blocks other receptors

11. Counter-irritation Pain and temperature signals use the same pathway to the brain Larger nerve fibers override smaller nerve fibers Skin irritation blocks pain signals to the brain

12. The Melzack-Wall Pain Gate

14. 14 Cryotherapy Cold application reduces the sensation of pain Cold reduces inflammation Cold and re-warming stimulates healing of tissue

15. 15 Cryotherapy Evaporation of alcohol and menthol reduces skin temperature Cooling stimulates cold receptors in the skin There is a link between cold sensitivity and pain

16. 16 What are the side effects of ice? Stiffness, decreased ROM (range of motion) Temporary pain and numbness Decreased motor performance Prolonged vasoconstriction (narrowing of the blood vessels) Skin irritation Risk of frostbite and nerve injury

17. Benefits of analgesics Allow for benefits of cryotherapy No side effects of ice

18. How do you apply topical analgesics? Different types of applicators – Roll-on – Spray – Gel 18

19. Roll-on Effective for smaller muscles Roller ball can be used for trigger points Biofreeze® Roll-on

20. Spray Easy application No direct body contact Gets hard-to-reach body areas Biofreeze® Spray

21. Gel Good for hands-on massage Larger muscles and joints Gel dispensing tube Pump bottle Biofreeze® Gel

22. 22 When to use a topical analgesic Before treatment for more productive session

23. During If client has soreness or pain during treatment

24. After Clients can use topical analgesics at home Supports treatment

25. Practice self application

26. What are the Contraindications? Open wounds Skin sensitivity Mucus membranes 26

27. Prossage Heat

28. References 1.Stanos Overview of topical analgesics. Pain Medicine News. 2009 Feb:1-6 2.Galeotti N, DiCesare Mannelli L, Massanti G, Bartolini A, Ghelardini C. Menthol: a natural analgesic compound. Neuro Science Letters. 2002Apr 12; 322(3): 145-8 3.Topp et al. Effects of menthol on skeletal muscle blood flow. 4.Proudfoot et al. Glutamate system 2006 5.Galaeotti et al. Opioid System 2002 6.Tuvenson et al. Cold sensitivity has been implicated in patients with chronic pain 2003 7.Melzak R, Wall PD. Pain mechanisms: a new theory. Science. 1965 Nov 19; 150 (699): 971-9 28

29. Topical Analgesics 101 Quiz

30. 1. Which of the following is an ingredient typically found in a topical analgesic? a)Butane b)Menthol c)Ascorbic acid d)Ammonia

31. 2. The gate control theory is which kind of pain control mechanism? a)Counter-irritation b)Cryotherapy c)NSAID d)Opiod

32. 3. Which of the following is where Topical Analgesics may not be applied? a)Arthritis b)Open wounds c)Bursitis d)Tendonitis

33. 4. Which of the following is a true statement? a)Topical Analgesics work by going into the blood stream. b)Cryotherapy decreases pain and reduces inflammation. c)Topical Analgesics can only be used after treatment d)Topical analgesics deliver systemic pain relief

34. 5. Which of the following is not a side effect of ice? a)Numbness b)Prolonged vasoconstriction c)Nerve injury d)Increased range of motion