21 Feb Overview of Topical Agents for Pain Relief
According to the U.S. 2012 National Health Interview Survey, 25 million American adults suffer from daily chronic pain, reporting severe pain that interferes with daily activities. Those with serious pain use healthcare services more often than the general population, and they also suffer from greater disability.
The National Health Interview Survey found that half of people with severe pain still rate their overall health as good. Women, non-Hispanics, and older persons were more likely to report pain. In addition, the study showed that the impact of pain on gender was influenced by ethnicity and race. People often turn to pills for pain relief, but one useful option often forgotten is topical pain relievers.
Topical pain relievers are creams, gels, ointments, and patches, that can be directly applied to the skin. Use of topical agents is an option for people who cannot tolerate oral medications, either due to swallowing problems or intolerability. A pain relief patch or agent can be useful for people who have pain in a very specific area (localized pain), such as the foot or lower back.
Choices of Topical Therapy
There are three main types of pain medicine that can be applied to the skin:
- Local anesthetics – These medications numb painful areas for a short amount of time. Lidocaine patches (Lidoderm) can help relieve pain, burning, aching, and stabbing discomfort that is associated with shingles (herpes zoster) and post-herpetic neuralgia. In addition, topical lidocaine spray or gel is available over-the-counter to treat sunburn.
- Pain medications – These drugs are applied directly to the skin in a form of gel, cream, or ointment. Anti-inflammatory drugs, such as diclofenac (Solaraze, Pennsaid) works by reducing inflammation. Aspirin creams work by blocking substances in the body that produce pain. BenGay and Aspercreme are two aspirin products available OTC.
- Counter-irritants – These products contain menthol, wintergreen oil, or eucalyptus, which irritate nerve endings and produce a cool sensation. Vicks VapoRub is a common counter-irritant that distracts the brain from the deeper sources of pain.
- Capsaicin – Derived from hot chili peppers, capsaicin works by inhibiting pain signal transmissions form the sensory nerves to the brain. This topical agent is used with neuropathic pain and helps with certain musculoskeletal disorders.
Compounded Topical Pain Medicines
Pharmacists can compound (formulate in the pharmacy) medicines so two or more agents are in one cream. Using FDA-approved ingredients, the pharmacist makes a topical pain cream that can be directly applied to the affected area or over the nerve source (dermatome). These creams are compounded with Lipoderm, an approved base that is prove effective in facilitating absorption of the medications. Ingredients include customized combinations of:
- Pain blockers – Ketamine
- Nonsteroidal anti-inflammatories (NSAIDs) – Ibuprofen, ketoprofen, and piroxicam
- Muscle relaxants – Baclofen, cyclobenzaprine, and guaifenesin
- Nerve agents – Gabapentin and amitriptyline
- Vasodilators – Verapamil and nifedipine
- Anesthetics – Lidocaine and prilocaine
Side Effects of Topical Agents
Because they are designed to act locally when applied directly to the skin, the drug levels in the body’s circulation are very low. However, these drugs still can produce some side effects, such as skin swelling, redness, or irritation. Should skin irritation occur, you should wash the area with soap. Symptoms also may be worse if the topical agent is applied in excess to the instructions, or if it is left on the skin for a prolonged amount of time.
Dr. Yeddu at Desert Interventional Spine Consultants is a top pain doctor in Chandler, Gilbert, Mesa and also sees patients from Queen Creek and Maricopa AZ. Patients are treated with compassion, respect and expertise. Most insurance is accepted, call today!
American Pain Society (2015). NIH study shows prevalence of chronic or severe pain in U.S. adults. Retrieved from: http://americanpainsociety.org/about-us/press-room/nih-study-shows-prevalence-of-chronic-or-severe-pain-in-u-s-adults