The Heat Is On -- And It's Enough To Drive You To Distraction

SELECTING JOE NAMATH WAS A clever move.

I'm not talking about the New York Jets and the 1964 NFL draft. I mean the Flex-All company, which in recent times picked the retired quarterback to promote its muscle-pain ointment.

Anyone who saw Namath pull the upstart Jets past the Baltimore Colts in the 1969 Super Bowl probably also remembers the knee problems he suffered.

If Namath could barely walk when he retired in 1978, imagine how bad it must be now. And how good Flex-all 454 must be to help him. Or so the thinking might go.

It's probably not coincidental that many of the folks who remember Namath's exploits are also those who increasingly are familiar with aches and pains. Baby-boomers, meet Ben-Gay. And Eucalyptamint, ArthriCare, Therapeutic Mineral Ice and a medicine cabinet full of others.

Do these products work? It depends on what you mean by "work."

There are two general kinds of rub-on muscle-pain ointments, according to Dr. Allan Ellsworth, associate professor of pharmacy and family medicine at the University of Washington. In one, the active ingredient usually is methyl salicylate. The other is geared around capsaicin.

"The methyl salicylates are really classified as counter-irritants," Ellsworth said. "They basically work by causing a lower-grade pain, which supposedly keeps the nerves busy by carrying that low-grade pain so that the deep underlying pain can't be transmitted."

Take a person with arthritis, he said. The methyl-salicylate-based ointment causes warmth and a burning sensation. That distracts the nerve fibers so the chronic pain signals can't get through.

"Essentially, the line's busy," Ellsworth says.

Methyl salicylate is pretty much aspirin, he says, but at a dosage so low it doesn't get into the bloodstream.

Capsaicin (cap-SAY-eh-sin), although now synthesized, originally was extracted from capsicum. As in hot peppers.

"I think they're effective," Ellsworth says of the capsaicin products. Although they can be counter-irritants (ever touched your mouth after handling a jalapeno?), their primary benefit is after two to three weeks of application.

"They slowly but surely deplete a substance, called `substance p,' which is integral in the transmission of pain signals from one nerve to the next nerve," Ellsworth says. Studies show it can reduce discomfort - such as chronic neurologic or arthritic pain - by up to 60 percent. Still, he considers the capsaicin products adjunct treatments, to be used in addition to oral medication.

Here's the rub (sorry): The methyl salicylates are easily available over the counter. But the capsaicin Ellsworth recommends (trade name Zostrix) comes only by prescription; he doesn't recommend the diluted version on the shelf.

Remember, though, Ellsworth is talking about chronic pain. Exercise-related aches and pains may be different.

Dr. Steven Rice is a faculty member of the UW's division of sports medicine, and is director of the Harborview Sports Medicine Clinic.

"If a person had tight, stiff muscles, they might have an injury," Rice said. "In the short run, they should decrease the blood supply by applying ice." He said they could actually increase the swelling by applying ointments that promote blood circulation.

Another potential problem, Rice said, is using analgesic rubs to mask the pain of a problem that should be treated differently.

For common aches and pains, he said, muscles should simply be iced at the end of activity. And a hot shower works just as well before exercise, to warm the muscles.

Rice also doesn't discount a psychological effect of these ointments.

"I kind of think people get emotionally dependent on them," he said. "I tell my patients that rather than rubbing it onto the muscle, they might as well rub it onto their forehead, because it's closer to the action."

Molly Martin is assistant editor of Pacific.