Selecting Topicals: Let Your Patient Be Your Guide

As previous articles in this series have shown, there can be a multitude of factors to consider when selecting equipment and supplies for your chiropractic office. Cost, company reputation and ease of use for the DC can all be factors. In the case of topicals, however, it all pretty much seems to come down to one factor - the patient. If they are satisfied with the results, then you know the product works. Dynamic Chiropractic PracticeINSIGHTS went to a panel of vendor experts to get their opinion not only on what qualities a chiropractor should look for when selecting a topical, but how to be successful marketing the product, which conditions are best suited for the use of topicals, and how they stack up against over-the-counter pain relievers.

(Editor's Note: In preparing this story, Dynamic Chiropractic PracticeINSIGHTS asked a panel of industry experts how they would go about investigating topicals if they were in the market to buy. Obviously, an expert allied with a particular company will tend to be biased to that company's products. Therefore, in this series, we report the comments that reflect a consensus on the general characteristics that make for a good product in order that you may make an informed decision as you do your research into a particular product or service.)

The Proof Is With the Patient

Let's be honest. Patients want fast results. If they get those fast results with very little unpleasant side effect, they will not only be willing to go along with your treatment plan, but they are also more likely to purchase that product that gave them those fast results. All of our experts agreed that this is the key to selecting and marketing topicals for the office.

Jean Shea, president of Biotone, located in San Diego, summed up this concept very neatly: "The easiest way for a practitioner to market a topical is to apply the product on the patient as a trial. If patients like the feel and the smell, and most importantly the results, more than likely, they will be interested in finding out more about the product and, in turn, purchasing it. When patients purchase topicals from a practitioner, they should feel a sense of confidence they are paying for a quality product that will provide needed results. Practitioners can be trusted to recommend and sell products that work."

Mark Mettler of Mettler Electronics, based in Anaheim, Calif., elaborated on the importance of not only a pleasant smell and feel to the topical, but its effectiveness. He stated, "Use the product in the clinic. Patients that use topicals that work, will want to buy some for home. Practitioners can also be more successful when they choose a product that smells good and works quickly. Patients can be turned off by bad medicine smells and obviously if it doesn't work, they aren't going to take it home."

Jeff Mathers with Performance Health, Inc., based in Akron, Ohio, agreed, explaining, "Use the product on patients before treatment. Teach patients about the benefits of the product and why you are applying it. Recommend that patients purchase the product for use between visits. Utilize marketing support provided by the companies."

Dr. Kim Vanderlinden of Hope Science, in Coronado, Calif., also keyed in on the advantage of using marketing material supplied by the topical manufacturer. He explained that it is key for the chiropractor to be on the cutting edge of knowledge regarding topicals: "When a better solution is available, but requires a little time for an explanation, consider this an opportunity to demonstrate your expertise and caring. Companies know the realities of a busy practice and that the time taken to explain a product can interrupt your practice flow. Educational brochures and Web sites not only save you time, but also have you appear as leading edge to your patients."

Educate Yourself

What Do Topicals Treat Other Than Sore Muscles? Probably the most common condition that topics treat are musculoskeletal issues. However, according to our experts, other conditions topicals can treat might include: arthritis carpal tunnel syndrome diabetic neuropathy fibromyalgia gout headaches insect bites leg cramps pain from shingles restless legs syndrome rheumatism sunburn

Obviously, the other half of this is properly educating yourself and your staff on how to sell the topical. This is where it becomes very important for not only the chiropractor but their staff to be as educated as possible about the product in question. Justin Toups, with China-Gel, located in Arlington Heights, Ill., explained the importance of having the staff on board with selling the product: "Educating and preparing the supporting staff with information and success stories (HIPAA-compliant, of course) is also critical. Often patients seek another voice of approval and if the feedback they receive from the doctor's staff is uninformed or ambivalent, they will be less likely to purchase. On the other hand, if the patient hears why the doctor carries the product and how it helps others, not only will the probability of purchase increase but also the comfort level with the decision."

Renate von der Beeck, with Kool Fit, also based in San Diego, also noted the importance of staff education and support, adding that chiropractors should "display the product prominently in your front office, instruct and inform your employees and CA about the product, and encourage them to recommend the product to your patients as an effective tool to minimize pain between office visits. Maybe offer a program to the employees and see who sells the most."

[pb]Of course, the easiest way to do this is with displays that are readily seen by the patient. Mettler elaborated on this by saying, "Make sure that they [patients] know the product is available for purchase. Point-of-sale displays and evidence of pricing can help."

Chiropractors may also want to think beyond just their office when it comes to promoting their practice through the use of topicals. Mathers suggested having small sample sizes available, adding, "Participating in community events, such as health fairs, fun runs and charity walks, is more than just a neighborly thing to do. It's an excellent way for the chiropractor to advertise their practice and help more people."

Conditions Topicals Can Treat

It may seem as though topicals are only designed to treat localized musculoskeletal conditions. However, according to our vendor experts, there is a whole host of other conditions for which topicals may be very well-suited to treat. Some of these may be found in the accompanying table.

Jeff Baskett, with Sombra Professional Therapy Products, headquartered in Albuquerque, explained that it's extremely important to keep in mind that not all topicals are the same. He explained, "Do not be fooled by thinking that topical analgesics are generic in nature."

Part of knowing which conditions will best respond to topicals is understanding the mechanism of action behind the product. According to Shea, "A topical works best and fastest on muscles and joints that are located close to the surface of the skin. Since a topical is absorbed through the skin, the location of the pain is very important. The further the pain is from the surface of the skin, the longer it takes to get relief."

Vanderlinden elaborated on this concept of where the pain might be located: "For example if a patient has a few spots of psoriasis a topical would be appropriate, but if the psoriasis is wide spread then an oral medication may be indicated. The same holds true for fibromyalgia, a few main trigger points and a cream would be great, but if the fibromyalgia is impacting several areas then a systemic approach may offer the patient more."

Stacking Up Against OTC Meds

One of the most common questions you might get from a patient is why your recommended topical is superior to pain-relievers they can buy themselves at their local drug store. The first thing is to understand the mechanism of action behind topicals so that you can better explain them to your patients.

Mathers gave a brief run-down on the method by which topicals that contain menthol stop pain. He explained that topicals "help break this pain cycle to facilitate therapeutic treatment by relieving pain through a method known as gate control theory, or 'gating.' In the gating theory, menthol acts to stimulate specific sensory receptors in the skin, thereby blocking other receptors from sending pain signals to the brain."

The key, as Mettler noted, is that most over-the-counter topicals don't contain the same amount of key ingredients such as menthol as those sold through chiropractors: "Most over-the-counter products don't have the same concentration of key ingredients like menthol, alcohol, and aloe vera. This usually leads to less-effective products. We hear stories all the time from customers who don't get nearly the same result from store-bought topicals."

One of the reasons for the lack of effectiveness of store-bought topicals is absorbability. Obviously, if the topical does not penetrate the skin, it cannot be very effective. As Vanderlinden explained, "The single biggest issue is absorption. If a topical is not absorbed topically, then by definition, it cannot reach sore muscles and joints. For a topical is to do more than temporarily mask symptoms, the compound must offer some degree of absorption. Skin permeability is highly selective and as a result, there are very few products that truly pass the epidermis, dermis and subcutaneous tissue layers of the skin, despite all the "deep-penetrating" absorption claims that we see in ads."

The other thing to consider is that over-the-counter pain relievers, particularly pills or capsules, can have unwanted side effects. Von der Beeck listed some of the problems that can occur with over-the-counter pain relievers: "When one considers the many problems associated with pain-relief pills that can upset the delicate stomachs of older people, wrong dosage dispensing, and the many contraindications that come with most pain medications, the use of a 100 percent natural topical analgesic that does not have to go through the digestive system and that offers effective pain relief, is a very viable alternative."

Quality and Effectiveness Are Key

The truth is that patients want pain relief that has been proven effective, and what better proof than if it works on them? At that point, its a very easy sell for the topical product.

Toups framed this question in terms of chiropractic obligation to the patient: "The chiropractor's primary obligation is the patient, which begs the question: 'is this a product that will help in the healing process or not?' An evaluation of the efficacy of the ingredients should be performed both in research and practical use of the product. This will determine if a particular topical should be recommended."

Baskett agreed, summing up, "When choosing a topical analgesic for patients a practitioner should first consider whether or not it can be used in their own treatments. The reason is that when a product is used during or after a treatment the practitioner obviously stands behind it and is an acting testimonial. The result is often an easy sell and the patient can then bring part of the rehabilitation process home with them. Chiropractic is a natural method of health care, so why not offer a topical analgesic that is naturally efficacious?"