July 07, 2017
Concerns over opioid addiction and updated cardiovascular warnings on nonsteroidal anti-inflammatory drug (NSAID) labels have more patients looking to topical agents for pain relief, according to a recent Pharmacy Times article (June 1, 2017).
Advantages of topical agents include a local delivery system and a significant decrease in side effects, wrote contributor Nicole Leimbach, PharmD. Her article includes a chart of topical agents and pros, cons, and clinical pearls linked with each. Here’s a summary:
- Diclofenac/compounds (ketoprofen, ibuprofen, piroxicam, etc.): These topical agents have a lower risk of systemic effects than oral NSAIDS and may be just as good for relieving osteoarthritis and acute musculoskeletal pain. They’re pricier, though, and have a heightened risk of dermatologic effects.
- Lidocaine patches: These agents may be helpful with neuropathic pain, but evidence is limited. Patients with sensitive skin may have issues, and potential toxicity could lead to death in users not counseled properly. The 5% patch is available only by prescription; the 4% patch is available over the counter. Lidocaine patches are a first-line treatment in patients who cannot tolerate or have systemic reactions to oral medications.
- Capsaicin: Topical capsaicin requires several applications a day and can take up to 4 weeks to kick in, but it offers potential help for osteoarthritis and rheumatoid arthritis, postherpetic neuralgia, and HIV neuropathy. Dr Leimbach recommends starting with lower doses and titrating up for tolerability. Patients should wash their hands after application and avoid heating pads.
- Menthol, camphor, Bengay, Icy Hot, etc.: These over-the-counter products are not designed for chronic or acute pain but may be beneficial for mild, short-term pain. Patients should wash their hands after application.
- TENS units, kinesiology tape: These are considered safe but should not be used on broken skin. Evidence for TENS unit effectiveness is conflicting and inconclusive. Good-quality evidence on the effectiveness of kinesiology tape is limited.