Making + Using Topicals for Pain
Which Topical Preparations are Best?
When it comes to treating pain you want to choose a preparation that is readily available or is the most convenient format for someone to use regularly. There are 5 basic topical preparations that can be used for pain:
Poultice - A poultice is good for emergencies when no other prepared medicines are available. A poultice can be made from fresh herbs (harvested from park, forest, garden) or dried herbs which have been soaked (pantry spices or teas). Poultices are very effective but are messy. They are better for short term use.
Compress - A compress is like a poultice but uses a cloth soaked in an infused herbal tea, rather than the crude herb directly. It is similarly good for emergencies when other prepared medicines are not available. It involves a couple steps and can also be messy. They are good for short term use.
Infused Oil - A well-made infused oil is a concentrated remedy for topical pain relief. If prepared with an appropriate high-quality oil along with added natural anti-oxidants, it will have a shelf-life of 12 months or more. It is a good remedy for intermittent or long-term treatment of pain. Single infused oils can be custom blended with one another; blended with a liniment 1:1; or made into a salve. It can stain clothing depending on the oil used (see notes below).
Salve - A salve is a less concentrated version of an infused oil which has been made into a more solid preparation when kept at room temperature. A salve is a good preparation for taking to work or for travelling, as it is compact and less messy than a bottle of oil. It will have a similar shelf life to an infused oil, possibly longer when essential oils are added. It can be layered over a liniment for dual action.
Liniment - A liniment is an alcohol-based preparation that is concentrated and has the longest shelf life of any other topical preparation. It has rapid and deep penetration making it ideal for quick acting pain relief. Alcohol extractions will have the widest range of constituents in the final product and is a good choice for resinous herbs. It can travel well in a roll-on container or spray bottle. It can dry out and irritate the skin when applied regularly, so a small percentage of oil should be added to the preparation; or it should be blended in a 1:1 ratio with an infused oil; or it should be layered with an infused oil or salve.
How Often should Topical Herbs be applied?
ACUTE PAIN: Use 3-4x daily for the first 5-7 days, alternated with icing or cold immersion.
Making Infused Oils, Salves and Liniments
How to Prepare a Liniment:
Macerate individual or blended herbs for 3-4 weeks in high proof vodka, over-proof alcohol, or rubbing alcohol in the same ratio you would make a tincture
Strain and press out herb material.
Add base oil or infused (10% of total volume or 10ml for every 100ml).
Adding oil provides ‘spreadability’ and reduces the drying effect of the alcohol. In a pinch, you can use a commercially available tincture from a manufacturer you trust. Liniments are a good choice of preparation for resinous herbs or messy (staining) herbs e.g. cayenne, cannabis, ginger.
How to Prepare a Liniment/Oil Combo:
Liniments can be blended with infused oils in a 1:1 ratio to provide dual action pain relief with an extended shelf life. The oils will provide an emollient effect on the skin and the alcohol will improve penetration. This type of preparation must be well shaken before each use to disperse the oil.
How to Prepare an Infused Oil:
Every herbalist has a favoured method for making infused oils, this is my approach. I use one of two potential base oils:
1) High quality cold-pressed olive oil.
2) Fractionated coconut oil.
After 18 years of running a massage practice I would never even consider using a polyunsaturated oil like grapeseed as a base, as they have a high capacity for rancidity. Fractionated coconut oil is unsurpassed in shelf-life, it is lighter than olive oil, has better penetration, and is non-staining.
To make the oil you can use a ratio of 7:1 or 7ml of oil for every gram of herb matter. Alternatively you can use the simpler’s method of just covering the plant matter fully with oil.
Method 1 - Indirect Hot Water Bath
Good for aerial parts (flowers, berries, twigs, needles, leaves)
Fill a slow cooker with warm water, line the bottom to protect the glass jar from heat stress and begin heating up to maximum 140 degrees.
Measure out and mix herbs with oil.
Place oil/herb mixture in blender and pulse a few times to break down plant matter.
Place the sluiced herbs and oil in a sealed jar.
Gently insert into the slow cooker and cover the cooker.
Turn off the heat and allow to bather for 2-3 hours or until the water cools off.
Allow to macerate for 2-4 weeks, shake regularly.
Strain through a fine mesh cloth and mix in 1 x 500IU capsule of vitamin E oil for every 200-250ml of infused oil.
Method 2 - Low Heat Infusion
Good for tough barks and roots.
Set slow cooker to ‘keep warm’ temperature setting.
Measure out roots/bark and pulse a few times in the blender to break it down.
Place herbs in slow cooker and mix in sufficient oil.
Gauge temperature carefully. Once the oil reaches 90-110 degrees, cover and turn off the heat to avoid burning the plant matter and spoiling the oil.
Allow to cool slowly. This cycle can be repeated for a deeper extraction, stir around regularly during re-heating process.
Strain through a fine mesh cloth and place into a sealed glass jar, mix in 1 x 500IU capsule of vitamin E for every 200-250ml of infused oil to increase shelf life.
I often macerate for 2-3 weeks before straining if I have the time.
Note on Using Fresh Herbs: I recommend wilting fresh herbs for 1-3 days to reduce water content and prevent spoiling.
How to Prepare a Salve:
Plan and measure for a 1:4 ratio of beeswax to infused oil. This will create a salve that is solid at room temperature, but pliable when worked with the fingers.
Pre-blend room temperature infused oils as desired.
Melt beeswax in a double boiler, slowly stir in infused oil (and essential oil if desired).
Pour into salve tins and don’t move the tins for 24-48 hours.
Although I have grouped the Materia Medica for Topical Pain Relievers according to acute, subacute, and chronic pain they are not limited to those categories. It is a way to help organize how you think about formulating, not a hard and fast rule. However, an important general rule would be avoid ‘hot’ herbs for acute inflammatory pain e.g. cayenne, ginger.
Work on blending herbs together to create the a range of effects specific to the type of pain, here are some examples:
Keywords: chronic, degenerative, stiffness, worse with humidity/dampness, poor circulation.
Comfrey or Solomon Seal (tissue healing, anti-inflammatory, promotes joint lubrication)
Juniper Berry (mild circulatory stimulation, flush excess fluids, reduce stiffness)
Ginger or Cayenne (powerful circulatory stimulation, anti-inflammatory or anti-nociceptive pain relief, reduce stiffness)
Wintergreen or Cannabis (relieves pain, reduces sensation of pain)
TENDONITIS or CARPAL TUNNEL SYNDROME
Keywords: acute/subacute, inflamed, irritated, nerve compression.
St. John’s Wort (specific for inflammation affecting nerves)
Wintergreen (cooling, soothing, pain relieving anti-inflammatory)
Solomon’s Seal (cooling, soothing, anti-inflammatory, tissue healing)
SPRAINS and STRAINS
Keywords: acute/subacute, tissue damage, inflammation, swelling.
Comfrey (rapid tissue healing, anti-inflammatory specific for injury)
Arnica (vulnerably, repair blood vessel damage, promote movement of blood)
Solomon Seal (promote tissue healing and tissue lubrication)
MUSCLE TENSION or SORENESS
Keywords: acute-chronic, soreness, stiffness, tension, congested heat.
Arnica (muscle soreness associated with overuse)
Valerian (antispasmodic, relieve tension, cramping and spasm)
Wintergreen (soothing pain relief)
Ginger (stimulate circulation, move congested heat.)
Working With Essential Oils
If ever there was place for essential oils, topical treatments for pain would be it! There is a lot of controversy in the herbal medicine world over essential oils (EOs) for several good reasons:
They are hyper-concentrated, making them toxic when not used correctly.
They are resource intensive, requiring mass quantities of plant material to produce small amounts of EO.
They can irritate and sensitize the skin and mucus membranes.
They should not be used with chemically sensitive people and be used in very limited scope with children.
If you decided to use essential oils in your remedies, stick with a 2% dilution rate for liniments, infused oils, and salves. That is 2ml for every 100ml of final product.
A 5% Dilution is the ceiling but is not advisable unless you are professionally trained in aromatherapy. 2% is a more universally tolerated dilution rate.
My favourite choices of EOs for topical pain relief include: Sweet Birch, Wintergreen, Rosemary, Marjoram, Eucalyptus, Spruce, Pine, Ginger.
They create a beautifully aromatic product and add to the pain relief profile.