What is the role of topical analgesics

Topical analgesics are applied directly over a painful site. Analgesic activity is limited to the peripheral soft tissues. Common analgesics utilized include:

• Capsaicin, the active component of chili peppers, is a topical analgesic cream that depletes substance P in small nociceptors. It may provide pain relief in patients with peripheral neuropathy, arthritis of small joints, and occasionally complex regional pain syndrome

• Lidoderm 5% patch is another topical treatment. The patch is applied over small areas of neuropathic pain. Anec-dotally, some patients with focal nociceptive pain also respond. The patches are worn for 12 hours and then taken off for 12 hours, but the analgesia is sustained. It is FDA approved for the treatment of postherpetic neuralgia

Key Points

1 It is important to differentiate nociceptive pain from neuropathic pain because certain medications are more effective for one type of pain than another.

2 Analgesics are the most effective medications for nociceptive pain and include peripherally acting analgesics (e.g. acetaminophen, aspirin, NSAIDs) or centrally acting analgesics (e.g. opioids).

3 The drugs of choice for neuropathic pain are anticonvulsants and noradrenergic antidepressants.

4 Muscle relaxants are a class of medications that do not specifically relax tight muscles but instead exert a therapeutic effect through sedation and central depression of neuronal transmission.

5 NSAIDs are extensively prescribed for spinal pain but have serious potential side effects related to the gastrointestinal tract, renal, and cardiovascular system.

Websites

1. American Pain Society Clinical Practical Guidelines: http://www.ampainsoc.org/pub/cp_guidelines.htm

2. Online educational resources: http://www.stoppain.org/for_professionals/default.asp

3. Pain evaluation and management: http://www.nlm.nih.gov/medlineplus/pain.html

4. Pain management topics: http://www.pain.com/

5. United States Regulations for Controlled Substances: http://www.justice.gov/dea/pubs/abuse/index.htm

BiBLioGRApHY

1. Chang V, Gonzalez P, Akuthota V. Evidence-informed management of chronic low back pain with adjunctive analgesics. Spine J 2008;8:21-7.

2. Gallagher R, Welz-Bosna M, Gammaitoni A. Assessment of dosing frequency of sustained release opioid preparations in patients with chronic nonmalignant pain. Pain Medicine 2007;8:71-4.

3. Katz N, Adams E, Benneyan J, et al. Foundations of opioid risk management. Clin J Pain 2007;23:103-18.

4. Malanga G, Wolff E. Evidence-informed management of chronic low back pain with nonsteroidal anti-inflammatory drugs, muscle relaxants and simple analgesics. Spine J 2008;8:173-84.

5. McNicol E, Horowicz-Mehler N, Fisk RA, et al. Management of opioid side effects in cancer-related and chronic non-cancer pain: A systematic review. J Pain 2003;4:231-56.

6. Schofferman J, Mazanec D. Evidence-informed management of chronic low back pain with opioid analgesics. Spine J 2008;8:185-94.

7. Urquhart D, Hoving J, Assendelft W, et al. Antidepressants for non-specific low back pain. Cochrane Database Syst Rev 2008;23:CD001703.

8. Yaksi A, Ozgonenel L, Ozgonenel B. The efficiency of gabapentin therapy in patients with lumbar spinal stenosis. Spine 2007;32:939-42.

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