Pain management is essential because, even when the underlying disease process is stable, uncontrolled pain prevents patients from working productively, enjoying recreation, or taking pleasure in their usual roles in the family and society. Chronic pain may have a myriad of causes and perpetuating factors, and therefore can be much more difficult to manage than acute pain, requiring a multidisciplinary approach and customized treatment protocols to meet the specific needs of each patient.
Topical creams and gels can be formulated to provide high local concentrations at the site of application (e.g., NSAIDs for joint pain), for trigger point application (e.g., combinations of medications for neuropathic pain), or in a base that will allow systemic absorption. Side effects associated with oral administration can often be avoided when medications are used topically.
Ketamine-Gel (Neuropathic Pain Gel)
Ingredients: Ketamine 0.5%
Description: The use of topical ketamine 0.5% (5 mg/ml) gel, applied as a thin film two to three times daily over a patient’s skin where the pain was severe reduced pain for patients with postherpetic neuralgia with no systemic side effects.
Neurology 2003;60:1391-1392
Topical ketamine treatment of postherpetic neuralgia
Dianna Quan, MD, Mary Wellish, BS and Donald H. Gilden, MD
Departments of Neurology (Drs. Quan and Gilden, M. Wellish) and Microbiology (Dr. Gilden), University of Colorado Health Sciences Center, Denver.
No abstract available. Click here to purchase the full article on line.
Doxecap Cream (Neuropathic Pain Cream)
Ingredients: Doxepin 3.3%, Capsaicin 0.025%
Description: The combination of 3.3% doxepin hydrochloride and 0.025% capsaicin applied daily for 4 weeks in 200 adult patients with chronic neuropathic pain has been reported to significantly reduce overall pain.
Br J Clin Pharmacol 2000 Jun;49(6):574-9
Topical application of doxepin hydrochloride, capsaicin and a combination of both produces analgesia in chronic human neuropathic pain: a randomized, double-blind, placebo-controlled study.
McCleane G
Pain Clinic, Craigavon Area Hospital, 68 Lurgan Road, Craigavon, BT63QQ5, N. Ireland.
Click here to access the PubMed abstract of this article.
Fast Migraine Relief
Ingredients: Indomethacin 25mg, Prochlorperazine dimaleate 4 mg, Caffeine 75mg
Description: A fixed combination of indomethacin 25 mg, prochlorperazine dimaleate 4 mg, and caffeine 75 mg is significantly more effective than sumatriptan 25mg in the acute treatment of migraine attacks.
Headache. 2003 Sep;43(8):835-44
Efficacy of a fixed combination of indomethacin, prochlorperazine, and caffeine versus sumatriptan in acute treatment of multiple migraine attacks: a multicenter, randomized, crossover trial.
Di Monda V, Nicolodi M, Aloisio A, Del Bianco P, Fonzari M, Grazioli I, Uslenghi C, Vecchiet L, Sicuteri F.
Neurology Division I, Spedali Civili di Brescia, Italy.
Click here to access the PubMed abstract of this article.
Migpriv (Migraine Relief Capsules)
Ingredients: Aspirin 900mg, Metoclopramide 10mg
Description: Migpriv is used for the symptomatic treatment of migraine headache and digestive disorders associated with nausea and vomiting. It has promising results when used to treat migraine attacks.
Tfelt-Hansen P.
Department of Neurology, Glostrup Hospital, University of Copenhagen, Glostrup, DK-2600 Glostrup, Denmark.
Click here to access the PubMed abstract of this article.
Ibu-Rub (Topical Ibuprofen Cream)
Ingredients: Ibuprofen
Keto-Rub (Topical Ketoprofen Cream)
Ingredients: Keotprofen
Description: To avoid the risks of COX-2 inhibitors, our pharmacy can compound topically applied NSAIDs such as ibuprofen and ketoprofen. Topical NSAIDs have a safety profile which is superior to oral formulations. Topical NSAID administration offers the advantage of local, enhanced delivery to painful sites with a reduced incidence of systemic adverse effects.
Topical non-steroidal anti-inflammatory drugs have a lower incidence of gastrointestinal adverse effects than the same drugs when they are taken orally. The low incidence of systemic adverse effects for topical NSAIDs probably results from the much lower plasma concentration from similar doses applied topically to those administered orally. Topical application of ibuprofen resulted in measurable tissue concentrations in deep tissue compartments, more than enough to inhibit inflammatory enzymes. Topical NSAIDs have not been associated with renal failure.
Reference: BMJ. 1995 Jul 1;311(6996):22-6
Topical non-steroidal anti-inflammatory drugs and admission to hospital for upper gastrointestinal bleeding and perforation: a record linkage case-control study.
Evans JM, McMahon AD, McGilchrist MM, White G, Murray FE, McDevitt DG, MacDonald TM.
Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee.
Free full text article available at bmj.com:
http://bmj.bmjjournals.com/cgi/content/full/311/6996/22
Click here to access the PubMed abstract of this article.
The following article concludes: Topical non-steroidal anti-inflammatory drugs are effective in relieving pain in acute and chronic conditions.
BMJ. 1998 Jan 31;316(7128):333-8
Quantitative systematic review of topically applied non-steroidal anti-inflammatory drugs.
Moore RA, Tramer MR, Carroll D, Wiffen PJ, McQuay HJ.
University of Oxford, Oxford Radcliffe Hospital, Headington, UK
Click here to access the PubMed abstract of this article.
BLT Cream (Benzocaine, Lidocaine, Tetracaine)
Ingredients: Benzocaine 20%, Lidocaine 6%, Tetracaine 4%
Description: BLT Cream is commonly used to numb the area at which a patient may feel pain. Particular areas that can be numbed include facial areas, and most general body areas
Reference:
Cosmetic Dermatology 2003 Apr;16(4):357
Topical Triple-Anesthetic Gel Compared With 3 Topical Anesthetics
Lee MWC
Department of Dermatological Surgery, University of California, San Francisco