Hi guys,
I had a patient when I was on my Musculo prac who liked to use skin irritants as a pain relief following her TKR. By skin irritants I mean using Deep Heat or any product like it. I knew that it wasn't effective in reducing the cause of the symptoms but for her it helped in reducing the symptoms. I was unsure on whether or not to mention to her that they produced no 'real' benefit to her knee. I talked to my supervisor and he said to educate her on the importance of ice but that telling her about the uselessness of the product wouldn't help her and therefore should be left alone.
I'm still not sure how I feel about this. I agree with what he said but at the same time I feel that by not saying anything I am promoting it. She will inevitably speak to other people about what she has gone through and recommend the product to others.
Does anybody have an opinion?
Thanks Brent
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3 comments:
Hello Brent!
I was just wondering if there has been scientific evidence which shows that deep heat doesn’t work? As you have mentioned it is pretty useless. Do you mean in terms of its pain-relieving property? It seems to me that Deep heat/rub is used by quite a number of people to soothe musculoskeletal aches and it does help to some extent.
My concern is more on if there are any contra-indications and precautions of its usage post-TKR since it’s a ‘deep heat’ agent but I don’t suppose its heat penetrating ability is as deep as it sounds compared to EPA agents like SWD? And also, at which stage post-TKR this patient is in, would ice be a better option than heat? If so, I will then explain to this patient the rationale on why we recommend ice this stage and heat at a later stage. I am not sure what is the presenting problem of this patient but presumably it’s on joint mobility and muscle strengthening, then I will explain to her how deep heat/ice are just symptomatic relievers and it will not help with her joints and muscles per se. So it is important that she undergoes physio for both management +/- treatment.
My conclusion is therefore, if there is no indication for the usage / benefit of ice at this stage, if there are no contra-indications / precautions to the usage of the deep heat, I will allow her to continue usage as it provides relief of her symptoms subjectively as you mentioned in your entry. The relief of her symptoms will then possibly make her more compliant/receptive to activities/exercises which is what we want! But I will make sure that she understands the need for other management to target the cause of her symptoms. Hope this helps!
Peiying ~
Hi Brent, as long as there is no danger in the pt using these creams (such as a skin allergy etc.) then I would support her continuing with this form of treatment. These creams can be beneficial depending on the situation and the pt for several reasons.
1. They make the skin feel different and this alone could decrease pain by distraction (various pain theories).
2. As with many other treatments out there (effective or not)the effect is partly a placebo effect. The pts belief that a product works is likely to decrease their pain regardless of whether the product has any actual benefit.
The use of deep heat is widely used throughout football clubs and is used in warm up massages to keep muscles warm - whether it does this or not i'm not 100% sure. When i've had it on my hands from massaging it in my hands feel very hot. Whether that heat is enough to increase blood supply in the skin or the muscles is another thing.
If the pt asked me if I would recommend it my answer would be that if it helps her that she should continue. If they were asking if they should try deep heat I would suggest they trial it for a week and if they don't feel better in that time to discontinue it. I would also say that if it works for the pt it doesn't mean it will work for someone else so if a friend is having problems they are best to seek medical advice rather than covering the symptoms with topical creams, and over the counter pain killers and NSAIDS.
Hope this helps.
Anna
Hello Brent
I too have had some questions in regards to the use of creams to relieve pain. It is an interesting topic as I feel that many patients feel that these creams could be a quick fix and will relieve pain almost instantly and permanently.
I myself have seen good results with the use of these creams. In saying this, I have always used them as an adjunct to heat, physiotherapy and EPA modalities and in many cases the cream is applied for inflammatory conditions. The cream by itself, especially with some pathologies, is unlikely to produce any significant change or long term result. As I discussed in my post on trigger point injection for myofascial pain, there are often biomechanical and underlying issues that need to be addressed in order for permanent change to occur.
If the patient feels they have some relief from applying the lotion and there are no contraindications, using the cream shouldn't be a problem. Use the cream as an adjunct to your treatment and hopefully the results will be even better.
Hope this helps. Heidi.
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