Topical Pain Medications: Which Ones Do the Job?by Mark Borigini, M.D. Health Professional
In a prior entry, I discussed Voltaren Gel. But there are some other prescription topical agents worth talking about this fine morning. Again, these medications have the potential to help all sorts of patients, but they may be particularly useful in those patients who have contraindications to the systemic side effects of pills. Then again, these topical agents are also good for those of us just tired of taking pills.
The Flector Patch is the first and only topical prescription non-steroidal anti-inflammatory drug (NSAID) patch available in the United States. The active ingredient in the patch is diclofenac, which is of course the generic name for Voltaren. So, if you have an ailment for which either the Voltaren Gel or the Flector Patch is indicated, and you don't like wiping gel off your hands, you may opt for the Flector Patch.
Indications for the Flector Patch include the treatment of acute pain due to minor strains, sprains and contusions. The CONTRAINDICATIONS include treating pain in the setting of coronary artery bypass graft surgery, treating patients who suffered severe allergic reactions with oral NSAIDs, to name a couple. Patients who suffer from coronary artery disease, high blood pressure, those who are prone to gastrointestinal bleeding or congestive heart failure or kidney disease are among those who should not use the Flector Patch.
But the bottom line is that this patch has an extensive track record of safety -- it is currently approved in over 40 countries, and I am not aware of any serious adverse event or death being reported in the more than six million patients who have used close to 200 million patches.
The Flector Patch measures approximately 4 inches by 5.5 inches. The dosing is one patch to the most painful area twice a day.
While we are on the subject of patches, let us not forget the Lidoderm Patch. At this time, this patch is officially indicated for relieving the pain associated with herpes zoster (shingles); but there have been papers published describing its beneficial effects in cases of arthritis and muscular pain/myofascial pain.
The Lidoderm Patch is a local anesthetic, and works by stopping the nerves from sending painful impulses to the brain. The active ingredient is lidocaine, which many dentists use to numb up the patient prior to a procedure. The side effects include confusion, dizziness, and a change in the regularity of the heartbeat, to name a few. Again, these are relatively rare, and patients should discuss with their doctors the risk of such side effects.
Finally, we should not forget capsaicin cream. This is the active ingredient in chili peppers. And it is used for a variety of chronic pain: back pain, bursitis, fibromyalgia, joint pain, muscle pain, nerve pain (including diabetic neuropathy), phantom-limb pain, the pain after a shingles attack, to name a few.
When applied to the skin, capsaicin cream reduces substance P -- a neurochemical that assists in transmitting pain signals. The patient using capsaicin cream would therefore be "desensitized" to pain. However, the reduction in pain is only temporary; capsaicin must be used regularly to provide continued pain relief.
Patients should be warned that capsaicin cream can cause a burning or stinging sensation on the skin and the eyes. So, wear gloves when you apply this cream, to avoid accidentally rubbing your eyes with hands full of capsaicin. The main side effect is this irritation. Don't forget that capsaicin is the active ingredient in pepper spray
In conclusion, there are a few topical medications on the market that have been shown to give targeted pain relief. For those patients with pain complaints that are more localized, these medications are certainly a relatively safe and effective option.