Painkillers with bruises

A bruise is a trauma of soft tissues of a closed type without disrupting the integrity of the skin, in the area of the bruise there is always a reaction from the damaged muscle tissue, fatty subcutaneous tissue, blood vessels. As a rule, the inflammatory process is characterized by a short duration, but it provokes pain sensations of the nociceptive type, which are capable of removing anesthetic ointments with bruises.

[1], [2], [3]

Indications for use

The pain symptom caused by damage to the subcutaneous tissue, soft tissues, is most often associated with bruises of varying severity and is the first clinical sign that requires anesthesia. In the treatment of contusio (bruise), analgesic ointments containing analgesic or anti-inflammatory components are used, often in combination with each other.

The application of a multicomponent ointment is aimed at solving such problems: 

• local anesthesia.
• reduction of hypoxia of soft tissues.
• stabilization of blood circulation, microcirculation.
• anti-inflammatory action.
• activation of resorption - resorption of foci of subcutaneous hemorrhage.
• reduction of puffiness.

Virtually all painkillers with bruises, produced by the modern pharmaceutical industry have a complex effect, monocomponent external agents are currently used rarely, since the bruise is not only pain, but also local inflammation, and a violation of the integrity of soft tissues.

Anesthetic ointments with bruises, indications for use: 

• Any trauma that does not violate the integrity of the skin.
• Contusions of soft tissues without gross violation of their structures (fascia rupture, crushing of tissues, muscle rupture, muscle bleeding).
• Dislocation, accompanied by damage to the subcutaneous tissue.
• Stretching muscles without breaking.
• Myalgia.

Ointments that can relieve pain with bruises are divided into three categories: 

1. Anesthesia with local cooling (cooling ointments).
2. Anesthesia with local irritating effect, warming ointments.
3. Anesthesia in combination with anti-inflammatory action - anti-inflammatory ointments.

Indications for use are due to the nature of the injury, which must either "cool down", or relieve the inflammation and thereby anesthetize the bruise. Correspondingly, damage is selected and the agent that has this or that pharmacodynamic property.

Pharmacodynamics

The regulation of pain in case of injury is based on the stimulation of sensory nerve fibers of type A, this helps suppress the transmission of the pain signal from the tactile mechanoreceptors. In this case, a local lateral slowing of the transmission occurs at the level of the spinal cord. A simple example as an argument is this - even a simple trituration of a meta injury, which is often performed automatically, can reduce the pain in the place of an easy bruise. In fact, the first anesthesia occurs immediately at the moment of rubbing the analgesic ointment, and only then does the pharmacodynamics of the drug components penetrating the percutaneous pain zone come into effect.

Thus, the mechanism of action of anesthetic external agents is due to inhibition and inhibition of nerve conduction.

Types of anesthesia with the help of an ointment form can be: 

• Terminal anesthesia.
• Infiltration anesthesia.

Terminal anesthesia (superficial) is the most commonly used method of anesthesia with bruises, when a temporary blockage of nerve receptors occurs. Infiltration method can be used in case of extensive bruises, accompanied by stretching, dislocations. Anesthesia is achieved by the gradual, layered application of the ointment, which is gradually absorbed into deeper layers of soft tissues, the agent thus acts not only on the skin surface receptors, but also on the fibers of the peripheral nerves that conduct pain. Ointment-anesthetics inhibit the transport of sodium and potassium ions by blocking the membrane channels of the nerves, which disturbs the conductivity of the nerve impulse. As a result, there is the effect of a partial loss of sensitivity in the area of application of the ointment without loss of conductivity in the distal or proximal zone of the nerve fiber.

In addition, the pharmacodynamics of anesthetic external agents can be associated with the specificity of the components of the ointment. Anesthetic ointments with bruises include such medicinal substances: 

• Methyl ester of salicylic acid or methyl salicylate (aspirin) - inhibits cyclooxygenase, which is considered the main enzyme for the synthesis of biologically active substances (prostaglandins) - the main molecules involved in the inflammatory process. Methylsalicylate inhibits synthesis, thereby reducing all inflammatory effects at the site of injury.
• Para-isobutylphenyl-ibuprofen, which is a derivative of aryl carboxylic acid. Ibuprofen inhibits the cyclooxygenase pathway of the prostaglandin compound.
• 3-Benzoyl-alpha-methylbenzeneacetic acid-ketoprofen, acting on lipooxygenase, cyclooxygenase, thereby disrupting the metabolism of arachidonic acid, the mediator of inflammation.
• Diclofenac Na is a diclofenac that slows down, inhibits cyclooxygenase, and reacts with arachidonic transfer.
• Para-chlorobenzoyl is indomethacin, also an inhibitor of the cyclooxygenase pathway for the synthesis of prostaglandins.

Pharmacokinetics

The pharmacokinetics of external anesthetics is due to their composition. As a rule, simple two-three component ointments with local application are not able to penetrate into the bloodstream and have a systemic effect on the body. Complex ointments, thanks to the incoming active components, can be partially absorbed into the blood, but this is typical for long-term courses of treatment, which is not shown with bruises. Even highly active external agents are rapidly eliminated from the body through the kidneys and liver, without causing significant side effects.

An overdose or prolonged, uncontrolled use of ointments containing ibuprofen may provoke the accumulation of the active substance in the blood plasma, but in very small quantities. As a result of metabolism, the products of ibuprofen disintegration are excreted through the kidneys with urine.

Names of analgesic ointments with bruises

1. Ben-Gay (Ben-Gay) - a combined external tool with an anesthetic and warming effect.
2. Analgos is a local irritating ointment containing propyl nicotinate, it enhances microcirculation of blood flow, dilates blood vessels, relieves pain.
3. Perlozon (Clofezon.) - ointment with local anesthetic effect and also anti-inflammatory effect.
4. Nikofleks, a combination of ointment, which includes capsaicin (local irritant effect), ethyl-nicotinate - an anesthetic effect, as well as lavender essential oil that intensifies anesthesia.
5. Lidochlor gel, stabilizing the cell membranes and inhibiting nerve conduction.
6. Balm "Sanitas" containing methyl salicylate. It has an analgesic and anti-inflammatory effect.
7. Voltaren Emulgel, a drug based on diclofenac, which can reduce inflammation, reduce pain in the area of injury.
8. Gevkamen - ointment based on menthol, quickly removing the first pain symptom, due to the content of essential oils is able to activate local blood microcirculation.
9. Deep Relief is an external remedy based on ibuprofen. First of all, the ointment quickly removes the symptoms of inflammation in the subcutaneous tissue, thereby reducing the degree of pain.
10. Dolgit is an ointment based on a non-steroidal anti-inflammatory drug (ibuprofen). The product is quickly absorbed into the skin, relieving pain and inflammation with bruises.
11. Dolobene, a drug based on dimethylsulfoxide, also includes heparin and dexapanthenol. Ointment reduces the pain symptom, puffiness, due to heparin has an anticoagulant effect.
12. Indovazin - an ointment based on intometacin, with the inclusion of a certain amount of troxevasin. It removes pain, inflammation, puffiness, improves blood filling of tissues, reduces the likelihood of their hypoxia.
13. Ketonal (ketoprofen) is an anesthetic ointment with anti-inflammatory effect.
14. Myoton on the basis of medicinal plant raw materials, warming up, causing short-term flushing, ointment reduces the pain symptom and activates the blood circulation in the area of the bruise.
15. Kapilar - cream, which includes turpentine from coniferous resin, camphor and essential oils. The remedy is used for bruises, hematomas as an anesthetic and blood-activating ointment.

The way of using anesthetics for bruises

The external method of anesthesia with the help of a drug in a dispersive form is considered one of the safest and most effective attraction of simple traumas. Anaesthesia by a percutaneous route does not affect the condition of internal organs and systems, since most of the ointment remains in the upper layers of the skin. In addition, to exceed the dose is almost impossible, excess ointment is very easy to remove from the injury site.

An anesthetic external agent is applied only to the area of injury, if the skin is damaged, they should be treated, and the ointment is applied only after wound healing or scratching. The method of application and dose of the ointment is indicated on the package, but it is usually recommended to lubricate the place of injury within the limits of the painful focus. Before applying, the skin should be treated with any antiseptic, since the cleared surface will promote a better absorption of the external preparation. Depending on the extent of the injury and its nature, as well as on what kind of ointment (warming or cooling) method and dose can be different. Warming ointments are used twice a day for 2-3 days, the drug is applied with light rubbing movements, the dose is determined by the boundaries of the injury, the diameter of the smeared focus should not exceed 15 centimeters for adult patients and 7 centimeters for children. The same rules apply to cooling agents. As a rule, the analgesic procedure does not require the application of a fixative bandage, occlusal fixation is needed only with extensive bruises accompanied by stretching or dislocations. The course of treatment with external anesthetics should not exceed 5 days, the therapeutic effect comes after 5-10 minutes and lasts not for long - not more than an hour. However, one should not get carried away with anesthetic ointments and apply them more often 3 times a day, and you should not allow a strong rubbing of the site of the injury.

Use of analgesic ointments with bruises during pregnancy

During pregnancy, you should be careful not only when using medicines in tablet form, but also in applying ointments, including ointments from bruises.

Use during pregnancy of means for anesthesia of easy traumas should be supervised by the attending physician. Ointments containing these components are inadmissible: 

• Methylsalicylates.
• Non-steroidal anti-inflammatory components, ointments containing diclofenac, especially in the third trimester.
• Ointments with the inclusion of snake or bee venom.
• Ointments with camphor or essential oils that can penetrate the bloodstream, and then into the placenta.
• Ointments of warming type, capable of provoking a violation of blood supply to the placenta and a slight hypoxia of the fetus.

In general, pregnant women should not risk themselves and allow bruises in principle, but if the trauma does occur, the treatment should be prescribed by the attending physician.

Contraindications for use

In spite of the fact that anesthetizing ointments with bruises are generally safe, they are not considered universal and have contraindications to the use. This is due to their multicomponent composition, in addition, NSAIDs in the composition are able to partially penetrate the bloodstream and provoke unwanted side effects in some groups of patients.

Analgesic external means - contraindications for use: 

1. The allergy in the anamnesis.
   • Allergy to non-steroidal anti-inflammatory drugs.
   • Allergy to methyl salicylates.
   • Allergy to essential oils.
   • Allergy to bee products.
2. Damage to the skin - a wound, a cut, scratches.
3. Dermatitis.
4. With caution in diseases of the kidneys and liver in the stage of exacerbation.
5. Relative contraindication - pregnancy and lactation.
6. Psoriasis, eczema.
7. Individual intolerance to the components of the ointment.
8. Children under the age of 1, 5-2 years.

[4], [5], [6], [7], [8], [9]

Side effects

As a rule, complications and side effects of external drugs with bruises are associated with improper application of ointments, or with their excessively frequent and abundant application. It is extremely rare with contusions of soft tissues such side effects can be observed:

• Redness, hyperemia of the skin in the area of injury.
• Burning, itching.
• Allergic rash.
• Very rarely - an allergic reaction in the form of Quincke's edema.

At occurrence of any atypical signs, deterioration of condition use of ointment should be stopped, a place of a bruise to process - to remove ointment. With side effects of the ointment in the form of a strong allergic reaction, desensitizing therapy is performed, in the case of swelling, difficulty breathing, lowering of blood pressure, you should call an ambulance.

In general, anesthetic ointments used with bruises are safe, their side effects in medical practice are practically not met.

Overdose

The bruise rarely causes severe and prolonged pain, so an overdose of anesthetic ointments is unlikely. Given the pharmacodynamics and pharmacokinetics of any external means, the ointment form is in principle not capable of a high degree of absorption. Such cases are possible only with the excessive zeal of the injured person who mistakenly believes that the more and more often he will apply the ointment, the faster the pain symptom and bruise that caused it will pass.

Extremely seldom excessive application of an anesthetic ointment can provoke a rash, itching, dizziness, headache, it may rather refer to a means containing essential oils. When these symptoms appear, the ointment should be discarded and replaced with a more gentle preparation, possibly on the basis of one active substance, an analgesic or an NSAID.

Even more rarely in medical practice there are cases of internal use of ointment, which quite naturally causes a negative response from the internal organs. Specific treatment or antidote for such situations does not exist, you should rinse the stomach or immediately seek medical help.

Interactions with other drugs

External agents in the form of ointments do not have the ability to systemic absorption, so their interaction with other drugs is acceptable without the risk of any complications. However, it should be noted that anesthetic ointments with bruises based on NSAIDs (non-steroidal anti-inflammatory drugs) can enhance the effect of oral administration of such medications in the form of tablets or injections. In such cases, a gastrotoxic and hepatotoxic effect is possible.

Also, attention should be paid to ointments with the inclusion of heparin, which enhance the effect of the tablet form of NSAIDs (analgesia), as well as to enhance the anticoagulant effect.

Interactions with other drugs in the form of external agents, for example, such as essential oils with cooling effect, only provide a quick anesthetic effect at the site of injury. Such a synergy can provide a tool in ready-made form - a multicomponent analgesic ointment. The mode of alternation of lotions with essential oil and ointment applications takes a long time and is not as productive as the use of the finished medicine in the form of an anesthetic ointment.

In general, the ointment from contusions does not provoke complications, it is well combined with other medicinal preparations, besides anesthesia is used only for a few days, which ensures relative safety of drug interactions.

How to store painkillers with bruises?

The terms and methods of storing the ointments are indicated on the original packaging and correspond to the technical documentation. In general, store any ointment should be in a dark, dry place, inaccessible to young children. The storage conditions for analgesic ointments are similar, they should be placed in a closet or a special box (first-aid kit), it is undesirable to store the ointment on the table, especially when accessing sunlight.

The temperature corresponding to the storage conditions of external anesthetic and anti-inflammatory agents should not exceed 15 degrees Celsius.

It is recommended to observe the storage conditions of external medicinal products according to the information on the package, since the influence of environmental factors - light, air, temperature changes, has an extremely adverse effect on the therapeutic properties of the ointment, reducing its activity. Light destroys the ointment base, it can separate, become heterogeneous. The vaseline base at high temperatures loses its absorption properties (sweat fluid). Ointment in a suspension form at an elevated temperature of the air in the room also loses its homogeneity, its disperse phases settle, and sedimentation occurs. The air temperature affects the gel forms of the ointment - it dries. Thus, in order to preserve the physicochemical properties of the analgesic ointments, they should be stored according to the specified rules.

Shelf life

Ready-made pharmacy products retain their pharmacological properties for 6-24 months, depending on the composition. Ointments manufactured extemporaneously are stored for no longer than 10 days.

Anesthetic ointments with bruises are applied no more than 3-5 days, if the pain symptom does not subside, you should consult a doctor and examine the place of the injury in order to find out its true cause and begin adequate treatment.