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Q & A with Dr. Sylvia Hesse

1. Tell me about yourself.

I graduated from the University of California, San Diego with a BS Cum Laude in Biochemistry/Cell Biology. Subsequently, I received a Doctor of Medicine degree from Creighton University School of Medicine. Upon completing an Orthopedic Surgery residency at the Fort Worth Affiliated Hospitals Program, I pursued subspecialty fellowship training in Pediatric Orthopedic Surgery at the Shriners Hospital for Children in Portland, Oregon.

I established a Pediatric Orthopedic Surgery practice in Miami, Florida prior to relocating to New York City. For nearly eight years, I have treated patients at a multidisciplinary musculoskeletal medicine clinic in midtown Manhattan, and am now a solo practitioner. I provide office-based, comprehensive non-surgical Orthopedic Medicine evaluations, with particular focus on adult and juvenile athletic injuries, chronic musculoskeletal overuse disorders, in addition to acute and chronic back pain disorders.

I strongly believe in a holistic approach to providing musculoskeletal medical care to my patients. By mindfully considering each patient’s unique functional and psychosocial requirements, I find that better and more lasting positive outcomes to conservative treatment can be obtained.

As an Orthopedic Surgeon, limiting my practice to non-operative care, I recognize when certain patient’s problems require surgical management, and arrangements for the appropriate surgical consultations will be made. I am currently completing certification training in the field of acupuncture. For my information on my practice, visit

2. What are the real differences between moderate and mild pain?

According to the medically recognized pain scale, which shows comparative pain scale from 1 to 10 (the chart is included in this kit); moderate pain “interferes with many activities and requires a lifestyle change with the person being unable to adapt to pain.” Minor pain “does not interfere with most activities” and the person is “able to adapt to pain psychologically and with medication or devices such as cushions.” Moderate pain is classified as “distressing,” “very distressing” and “intense.” Hence, an OTC aerosol, cream or pain patch that can alleviate moderate pain and empower a person to engage in normal activities is quite significant.

3. Is topical drug therapy more common in Europe and Asia than the United States?

Yes, while topical or transdermal drug therapy is common in Europe and Asia, the United States is still predominately a pill culture. Transdermal means “through the skin”, and includes the use of a medicated patch, gel, or cream that is affixed, rubbed or sprayed onto the skin. Unfortunately, when people self-medicate with over-the- counter oral pain medications, they can ingest inappropriate doses and run the risk of potential drug interactions, which can lead to unintended or unsuspected dangerous side effects, some of which can be as serious as liver failure or heart damage.

While taking an acetaminophen pill for pain is safe when following the package directions, problems can arise as the result of a single intentional or accidental overdose. Even frequently taking a dosage of acetaminophen that is too high can result in overdose. Acetaminophen is also a common ingredient in a wide variety of non-prescription and prescription products, and accidental overdose is often the result of taking multiple products that contain this ingredient. Even though it is safe when taken appropriately, it can be very dangerous if you take too much, and overdoses can lead to death or liver damage.

Similarly, an overdose of ibuprofen can cause life-threatening heart or circulation problems, such as heart attack or stroke, especially if used long term. Ibuprofen may also cause damage to the stomach or intestines, including bleeding or perforation. These conditions can be fatal, and can occur without warning while a person is taking ibuprofen, especially in older adults.
Consumers must remember that just because a product is available over the counter, doesn’t mean it’s not a potent medicine. Any medication needs to be taken as directed.

The American College of Preventive Medicine reports that “one third (33%) of Americans admit that they have taken more than the recommended dose of an over-the-counter (OTC) medicine thinking it will bring more relief more quickly, help with severe symptoms, or because they did not obtain relief after taking the recommended dose.”

Be MedWise, is a public education initiative by the National Council on Patient Information and Education (NCPIE) – a nonprofit coalition of over 125 consumer, government, patient advocacy and public health organizations that is a great place for consumers to go to get a better understanding that OTC drug products are serious medicines that must be taken with care.

4. What is the market size of the nonprescription pain relief marketplace?

In the United States, the nonprescription pain relief marketplace exceeds $2 billion per year for oral and topical dosage forms including tablets, capsules, ointments, gels, creams and patches.

5. What are the advantages of topical drug delivery in the form of cream, gel, and patches versus other types of medication delivery for pain management?

Topical creams, gels, and patches offer a unique way of delivering medication to your body which offers distinct advantages over taking medications orally. One of the biggest advantages is that the medication is delivered directly to the site of pain. Direct application allows a higher concentration of the drug to reach the tissue that needs it. The total amount of medication absorbed into the bloodstream is low, leading to a very low incidence of side effects, in contrast to oral medications. Topical treatments can use less medicine and get the same or better relief.

6. What types of pain can external pain products alleviate?

Topical creams, gels, and patches are proven to work on mild to moderate pain and are effective for muscle and joint pain, arthritis pain, shoulder pain, back pain, neck pain, and strains, sprains and bruises.

7. Is a topical analgesic more effective than a pill for pain management?

Topical analgesic medication, like a cream, gel, patch, or spray, provides a welcome alternative for pain sufferers, including those who prefer to avoid the use of oral OTC pain relief medication. Transdermal pain preparations penetrate directly to the site of the pain – providing a fast therapeutic benefit. Oral medications must travel through the digestive and circulatory system, and only a small proportion of the active drug is available before, ultimately, reaching their target tissue.

Especially given all of the recalls that have happened lately with oral pain relievers, I find that my patients are looking for something that is safer and offers lower side effects.

8. What is your experience with the new Deep Relieving Gel from Salonpas?

Hisamitsu America, the manufacturer of the Salonpas products, sent my office samples of the new Deep Relieving Gel that will be available in retail outlets by the summer of 2013. The feedback from my patients has been purely favorable. The consensus had been that it provides effective, long-lasting pain relief, which allowed them to resume normal activity levels more quickly.

Dr. Silvia Hesse

MD, Orthopedic Medicine

  • Manhattan Spine & Sports Medicine Center