Q:  Are over-the-counter remedies for arthritis any good?

A:  It may surprise you to learn that many of my arthritis patients find good relief with products such as Aspercreme, Ben-Gay, Vics VapoRub, and other ointments.

The effectiveness of products like these is thought to be due to competition for different sensations getting into the spinal cord and the brain. Think of this scenario as a gate to a tollbooth. When the body sends along competing sensations, namely a painful joint followed by a distinctive warmth or tingling from a cream, both cannot pass through the gate at the same time. The pleasant counter-sensation may be strong enough to shove aside some of the pain sensation.

In addition to soothing creams or ointments, over-the-counter or nonprescription analgesics work well. They generally fall into two categories: the extended family of anti-inflammatories, which includes aspirin and ibuprofen (sometimes referred to as NSAIDs-nonsteroidal anti-inflammatory drugs) and drugs that contain acetaminophen, which are questionable anti-inflammatory agents but potent pain relievers.

Over-the-counter drugs like aspirin and ibuprofen are excellent pain relievers and also reduce redness and inflammation. Aspirin, chemically known as acetylsalicylic acid, has been available without a prescription since 1915. Ibuprofen was not as widely available until the mid-1970s. Upjohn Pharmaceuticals, the maker of Motrin, received Food and Drug Administration (FDA) approval to market the drug in 1974, and within the next two years, the company churned out 1.7 billion tablets of it.

Acetaminophen (Tylenol) is an over-the-counter pain relief drug that, while effective, is not as trouble-free as its availability suggests. In low doses over short periods of time, it does a good job. It rarely irritates the stomach and kidneys and does not cause ulcers like aspirin and other anti-inflammatory drugs. However, it can be hard on the liver, especially when mixed with alcohol or taken by an individual with prior liver disease. Taken in high doses or for a long time, it can even produce outright liver failure and, in the extreme, necessitate a liver transplant.

Despite the widespread use of Tylenol, scientists do not know exactly how it suppresses pain. Researchers are intrigued by its pain-relieving potential and think it possesses unknown properties that could lead to a more effective analgesic. It is possible that it harbors special properties akin to other novel analgesics that may help make angry pain nerves less irritable.

Scott Fishman, M.D., is a leading expert in pain management.