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handful of medical pain authorities argue that over-the-counter creams do have a place in treatment. Kallgren,

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medical director of pain medicine at the Oregon Anesthesiology Group in Portland, who published research last year on the success of topical salicylate cream for muscle and joint pain. But some work, and if they do, I don � t care if

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the Clinic says there � no study to prove it.

But he did not think the products helped to heal injured or fatigued muscles or joints. The study

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sho that � people who used JointFlex over time continued to experience pain relief, � Mr. Sure, but there � no evidence to support that topical analgesics actually work.

� We try to treat based on the scientific literature, and I personally haven � t seen a lot of good literature supporting the use of topical analgesics, � said Dr.

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These users, like athletes, may benefit from the creams � placebo effect, a few doctors said, which can cause patients to feel that an inert medication works simply because they are told it will. � We don � t always know how things work, but that doesn � t mean they � re a placebo or a sham, � said Dr. � So

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unless someone does a double-blind study with lots of proof, we really don � t have good evidence that these products make any difference. Do Sports Creams Rub the Pain Away. Indeed, the medicinal smell of many of these creams is ubiquitous in locker rooms (that smell comes from methyl salicylate, an ingredient ALCiS does not include). Eugenius Zeltzer, president of the special interest group on

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pain in childhood for the International Association for the Study of Pain.

Some doctors point out that no physical changes occur at the spot where the creams are applied even if they give the not-unpleasant sensation of heat or cold and suggest that the only real benefit could be that of a placebo. � If you give somebody a medication and tell them

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it � going to work, it � going to work for a few people, � Dr. Lumber said before she was scheduled

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� � There are people who use creams and swear by them, and others who say they don � t work at all, � said Dr. Cagle said of the 2003 research. Last year, external analgesic

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rubs had approximately $275 million in sales in the United States, excluding sales at Wal-Mart, according to the Chicago-based market research firm Information Resources.

� Ed Ryan, who was the director of sports medicine for the United States Olympic Committee for much of the past decade, estimated that at least 70 percent of the athletes he

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treated had experimented at least once with over-the-counter pain creams. � I used to be very limited in what I could do, but now I can go for a two-hour hike around the mountains, � Ms. � Not all consumers purchase pain creams for sports-related problems.

� They don � t cause a change to occur that would result in any pain decrease or any physiological change that would hasten healing. Geri Sallis, immediate past president of the American College

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of Sports Medicine, agrees. But can they help people feel better because there is a placebo effect. � ALCiS is one of several successful new products to enter a large, longstanding and lucrative market for over-the-counter topical analgesics, or pain creams, an industry that includes Bengay, Icy Hot, ThermaCare and Aspercreme, and has been part of United States retail since before the turn of the 20th century. � Manufacturers of topical analgesics, not surprisingly, say they work.

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� But anything

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that sticks around for as long as some of these products have must have some benefit or else athletes wouldn � t continue using them.

Lumber, who lives in Portland, Ore., started using a prescription product along with the over-the-counter pain-relieving cream ALCiS. � It � not necessarily that we � re arguing against what any doctor would say, but the product itself has been shown to

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be very effective against a placebo over a term of

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time. The research is so minimal and inconclusive that doctors at the Sports Medicine Center at the Clinic in Minnesota refused to comment on the efficacy of topical analgesics, saying in an e-mail message, � There is no science to either support or refute the effectiveness � of the products. Studies have found only limited evidence that over-the-counter topical analgesics are helpful for any type of pain. But do the majority of people find it to be effective.

Does it work for every person who

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Sports Medicine in Indianapolis agree. Trixie LUMBER, a 56-year-old retired tennis pro, experimented with different over-the-counter sports creams for more than five years in the hope that one might ease the pain she had suffered since having knee-replacement surgery. � But in sour economic

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times is the notion that a topical cream might work for some people some of the time enough to prompt consumers to purchase or continue to purchase a product. � There � no clear evidence that these creams work, � Dr.

� ALCiS has managed to keep everything very comfortable. � I � ve tried lots of products with my patients that are completely worthless. Obidiah Cagle, president of Alterna, which makes

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the topical analgesic JointFlex, pointed to several clinical studies, including one published in The Journal of Rheumatology in 2003. � Do topical analgesics help heal the injury or get an athlete back to activity any quicker. � I think that has to do with how often you apply them, the penetration and patient persistency and expectations. Many try them to alleviate muscular or joint pain associated with arthritis, age-related stiffness and conditions like fibromyalgia, in addition to sports injuries and fatigue from physical activity.

� From a physiological standpoint, there � very little benefit that occurs in the tissue where you � re applying a cream, � he said. Lumber � experience, and despite those big sales numbers, there is scant evidence that any of the creams actually work.