Physical Therapy Products recently spoke with Phil Page, PT, ATC, MS, CSCS, manager of clinical education and research for Hygenic Corp, Akron, Ohio.

Describe the importance/significance of the Biofreeze® product ingredients.

The main ingredient in Biofreeze topical analgesic is menthol. Topical analgesics are classified as "counter irritants," which are thought to reduce the sensation of pain through the Gate Control Theory by Ronald Melzak and Patrick Wall. Recent research on menthol, however, has found new insight to its mechanisms via stimulation of cold receptors in the skin. Menthol has been shown to stimulate specific cold receptors that are thought to control pain through the opioid or glutamate system, which is how some pain medications work as well. Research is now looking at the role of menthol in controlling chronic musculoskeletal pain.

What are most rehabilitation professionals looking for in a topical analgesic for their patients?

Most important is that it works. They want something that is fast-acting and provides long-lasting pain relief. Clinicians also want something that's easy to apply so they don't have to apply it with their hands to 10 patients, for example. Biofreeze topical analgesics come in gel, roll-on, and spray formulations for a variety of delivery mechanisms. The convenient patient sizes also are ideal for patients to use at home.

What is the role of cryotherapy today in the physical therapy niche? How has it evolved?

Cryotherapy has been a standard treatment in rehabilitation for many years. As recently as 40 years ago, we were applying heat to acute ankle injuries. In the '70s and '80s, we started to learn about the benefits of cryotherapy through research primarily done by Ken Knight, PhD. Unfortunately, Medicare stopped reimbursing for "ice pack" treatments in the '90s, and began "bundling" the treatment in other codes. This may have led some clinicians away from cryotherapy, which is typical of many treatments that lose reimbursement. I see cryotherapy as making a comeback in clinics as a primary pain treatment, particularly as we see more research on cold and pain.

What future trends do you foresee in this product niche?

With the recent menthol research on the effects of cryotherapy on pain, I think we're going to see more use of topical analgesics as a "natural" pain reliever, particularly with the increase in patients with osteoarthritis. For example, Biofreeze topical analgesic can provide some benefits of ice (pain relief, decreased blood flow, and decreased skin temperature) without the potential side-effects of ice (stiffness, skin irritation, nerve damage). In fact, the American College of Rheumatology and the American Heart Association are recommending more nonpharmacological approaches to pain management in osteoarthritis through physical therapy and topical analgesics before prescribing drugs due to the side effects of some NSAIDs.

Is there a particular treatment protocol that makes this product more effective for patients?

It's important to remember that topical analgesics (or any pain reliever, for that matter) are only addressing a symptom (pain) of an underlying condition. We must understand that therapeutic exercise has been shown to be the best treatment for most musculoskeletal conditions such as osteoarthritis and chronic low back pain. I recommend always combining Biofreeze topical analgesics with a therapeutic exercise program, applied before and after exercise, up to four times a day. Clinicians can also incorporate Biofreeze topical analgesic into their clinical treatments by applying it before and after interventions such as joint mobilization to reduce patient apprehension.

In addition to helping treat patients' level of pain, does offering Biofreeze have business benefits for PTs?

Definitely. Biofreeze topical analgesics are only sold through health care providers; Biofreeze is not available in retail stores. This makes an excellent opportunity for clinicians to increase cash-based revenue through in-office dispensing of Biofreeze topical analgesic. We also offer a free sampling program for clinics that includes custom imprinted brochures with the clinic name and address, stapled with two sample packs. Clinics can provide these samples to their patients to "try before they buy," or they can provide these samples at community events such as screenings, health fairs, or marathons. We've heard stories of patients returning frequently to purchase the product from their health care providers, and even buying some for their friends!