In the world of pain management, typically one thinks of patients taking pills by mouth for pain relief. These would include such medications as nonsteroidal anti-inflammatories, narcotics, Tylenol, and there are some newer non-narcotic medications available. This article will not discuss topical pain patches like Fentanyl, which are designed to emit pain medication systemically.
However, there are some topical medications available for pain management. This is important because a lot of people experience pain in a focal anatomical area. They may have bad arthritis in one knee, or a focal area of the back. When patients take medication by mouth, they get into the bloodstream and can have systemic effects such as gastrointestinal complications, bleeding complications, or maybe in the case of narcotics problems with addiction or constipation. So having a topical medication applied over the area of pain will be great if it works.
One of the newer options available for topical pain management which is a nonsteroidal anti-inflammatory called Voltaren. This is available as a 1% gel that can treat joint pain all over the body such as in the hands, wrists, elbows, knees, ankles, or feet.
There is also a higher concentration gel available which is used to treat knee pain from osteoarthritis. This gel in a higher concentration is also made of Diclofenac but represents a higher concentration than 1%. It is actually at 1.5% and only approved for usage in the knee because that’s where the studies were done. The medication is called Pennsaid which is short for penetrating nonsteroidal anti-inflammatory drug.
This particular medication was compared to oral agents for pain specifically in the knee. What they found is that the effectiveness was equivalent to oral medications, yet patients were able to avoid the side effects that could potentially be associated with the medication by mouth.
Also, diclofenac is available in a patch format to help with acute strains and sprains in a localized area such as in the lower back. There is also a Lidocaine patch which has numbing medication that can be very helpful. The FDA has only approved the medication for post-herpetic neuralgia. However, it is commonly used off-label for many other conditions such as acute back pain or even around wounds from surgery.
There is another topical agent available which is over-the-counter and named capsaicin. This medication works on a receptor in the skin which is a sensory receptor and can help turn it off and decrease pain. Capsaicin is made as an extract from chili peppers so a lot of people call it pepper cream.
Capsaicin is available as a cream, it is also available in a patch format which unfortunately is fairly onerous to apply because of the potential for aerosolized the medication which can be caustic.
More and more, the potential exists for topical medications to help minimize the amount of oral medications needed for pain relief which can hopefully decrease potential side effects. More research continues to come out showing that the skin is extremely important in pain generation and a lot of patients so the potential for these topical medications is tremendous.
David L. Greene, MD, Phoenix, AZ is CEO of Preferred Pain Center which serves the Phoenix and Scottsdale, AZ metropolitan and surrounding areas. He can be reached at [email protected] and (602) 507-6550.
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