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Working folks today i want to talk a few minutes about topical pain agents we have been talking about different pain medication and topical pain medications they are also useful to control pain and they have several potential advantages our systemic drugs first of all you can deliver them at the site of insult and also they have the low rates of systemic absorption
Like for example as you know most of these pain medications can give acid reflux problems they can cause peptic ulcer in chronic use but these topical agents they don’t have those side effects so some people they actually prefer particle agents because of those less side-effect profile so the patients often perceived topical preparations to be safer than they’ll
Worrell equivalence so significant systemic concentrations can result with practical application and systemic side effects are also possible so don’t think that because these are topical they don’t have systemic side effects they can still cause systemic side effects even though they are less let me give you a few topical agents today number one topical lidocaine
Topical lidocaine people use it i saw one lady she pulled out a lidocaine patch on her back and asked her easily helping you she said yes it helps me a lot so there is this patchwork that their house a 2014 systematic review it concluded that in the aggregate while there is little evidence to support the use of topical lidocaine to treat new but the pain results
From individual studies and clinical experience there suggests that it can be effective in some patients the five percent lidocaine patch as shown efficacy and excellent tolerance in people especially people with post herpetic neuralgia and allodynia and in patients with other dania with different types of peripheral neuropathy pain now what is alert idea basically
Allodynia is pain due to stimulants which are normal many times basically let us say i went under the sun everybody’s enjoying the sun oh like a warm nice day but i am having pain because of the sun so that is allodynia so i have a load idea – the warm sun and people can have different different things people can have a load idea – even cold and a fan like hail
For example if you turn your fan and the a machine fall and people say hey i am having this pain that’s a load idea we said i am enjoying this fan but some people say it’s causing me pain so basically they are not crazy they are experiencing back pain so this pain many times there could be peripheral neuropathy here and they benefit a lot from these topical agents
Lidocaine gel is available 5% it is like sex expensive than the patch and it also is efficacious in patients with post herpetic neuralgia and aller diarrhea and particle lidocaine is most appropriate for patients with well localized neuropathic pain although it can be used as the mana therapy it is often used as an adjunct to systemic medication then the other one
The chile claim right people ask give me some chilly cream basically this is capsaicin cream it’s an alkaloid derived from chile peppers repeated application is often thought to deplete substance p from primary afferent neurons so basically this medication it depletes substance p and it gives pain relief basically the mechanism of action to be honest with you is
Not really clear but what is happening is this chili pain is actually dominating the real pain you are having and giving you a sense of relief a systematic review form that capsaicin had moderate to poor efficacy for relief of chronic muscle skeletal or neuropathic pain but might be useful as an adjunct therapy or for patients and unresponsive to other treatments
Capsaicin has been used in patients with posner and particular algea hiv neuropathy and diabetic neuropathy caps i simply must be applied 3 to 4 times per day well then type painful av and give it like maybe i would say six seven weeks and you can also use a patch this patch is like a take that skin and apply for 60 minutes but major adverse effects are burning and
Stinging and rit my at the site of application leading to intolerance in up to 30% of patients so capsizing cream it helps in some patients then ends x some of them says we have like a lot of nz’s in the water form but there are also some enzymes like diclofenac which are available in topical form so basically this topical far either you patch our gel or spray our
Cream it gives modest relief for acute mosquito musculoskeletal pain evidence of effectiveness for these agents for chronic low back pain or chronic musculoskeletal pain for chronic peripheral neuropathy pain is not that strong so these are good in acute pain a systematic review of full randomised trials found that the tropical 1.5% diclofenac was more effective
Than a control vehicle in the relief of knee osteoarthritis pain and it was well tolerated a systematic review found that response rates for topical celsius for chronic pain are lower than tropical diclofenac then there is topical doxepin so topical doxepin basically it is available in particle formulation for the treatment of providers that is itching but some
People say it is also helping the pain you say we don’t know i mean when they when it is giving sometimes even histamine can cause pain because histamine it is it releases that do the transmitters and it can cause pain so when you are using this doxepin and when it is treating the providers patient might get pain relief so even though the mechanism of action here
Is not that clear based on patient’s experience we can say it is effective in some patients so those are the main points i want to discuss with you today about topical pain management and you are welcome to come to my clinic if you need a prescription for topical lidocaine or topical diclofenac i am prescribing right now topical diclofenac for peche with pain
Like osteoarthritis and i would be happy to evaluate you thank you so much you
Transcribed from video
Topical Medications for Pain Control By USMLEVideoLectures
