Skin Matters: A Review of Topical Treatments for Chronic Pain. Part Two: Treatments and Applications

Abstract

In Part One of this two-part series, we discussed skin physiology and anatomy as well as generalities concerning topical analgesics. This modality of therapy has lesser side effects and drug–drug interactions, and patients tolerate this form of therapy better than many oral options. Unfortunately, this modality is not used as often as it could be in chronic pain states, such as that from neuropathic pain. Part Two discusses specific therapies, local anesthetics, and other drugs, as well as how a clinician might use specific aspects of a patient’s neuropathic pain presentation to help guide them in the selection of a topical agent.

Critical illness and multi‐organ failure following topical application of skin‐lightening preparation

“…Many of these agents are available as non‐prescription, over‐the‐counter products and can be purchased from sources providing no qualified medical advice in their use. Moreover, topical preparations are available in a wide range of concentrations and formulations, including gels, ointments, lotions, sprays and transdermal patches . Prolonged, repeated or inappropriate administration can lead to adverse events and non‐efficacious use, resulting in harm .…”

Acute and chronic pain in orofacial trauma patients

“…60 Topical treatments can also be applied to the affected area and have the benefit of a reduced side effects profile, less drug-drug interactions, and higher patient compliance and tolerance. 62,63 Individually prescribed topical formulations with a combination of NSAIDs and AEDs have been reported to be effective treatments. 62,63 Individually prescribed topical formulations with a combination of NSAIDs and AEDs have been reported to be effective treatments.…”

“…61,62 Evidence-based topical treatment use includes lidocaine or capsaicin patches. 62,63 Individually prescribed topical formulations with a combination of NSAIDs and AEDs have been reported to be effective treatments. 61 If the initial medication used is unsuccessful in relieving the patient's symptoms, a different class of medications should be considered ( Table 2).…”

A Review of Intravenous Lidocaine Infusion Therapy for Paediatric Acute and Chronic Pain Management

“…Topical lidocaine reduces nociceptor discharge at the level of the skin, to enable a light mechanical stimulus to induce a sense of touch, not pain. The analgesic effects of topical lidocaine probably do not require anaesthesia to the skin [258]. When lidocaine patches are used according to the recommended dosing instructions, only 3 ± 2% of the dose applied is expected to be absorbed.…”