Elsevier

Mayo Clinic Proceedings

Volume 88, Issue 2, February 2013, Pages 195-205
Mayo Clinic Proceedings

Review
Topical Analgesics in the Management of Acute and Chronic Pain

https://doi.org/10.1016/j.mayocp.2012.11.015Get rights and content

Abstract

Oral analgesics are commonly prescribed for the treatment of acute and chronic pain, but these agents often produce adverse systemic effects, which sometimes are severe. Topical analgesics offer the potential to provide the same analgesic relief provided by oral analgesics but with minimal adverse systemic effects. This article describes the results of a systematic review of the efficacy of topical analgesics in the management of acute and chronic pain conditions. A literature search of MEDLINE/PubMed was conducted using the keywords topical analgesic AND chronic pain OR acute pain OR neuropathic pain and focused only on individual clinical trials published in English-language journals. The search identified 92 articles, of which 65 were eligible for inclusion in the review. The most commonly studied topical analgesics were nonsteroidal anti-inflammatory drugs (n=27), followed by lidocaine (n=9), capsaicin (n=6), amitriptyline (n=5), glyceryl trinitrate (n=3), opioids (n=2), menthol (n=2), pimecrolimus (n=2), and phenytoin (n=2). The most common indications were acute soft tissue injuries (n=18), followed by neuropathic pain (n=17), experimental pain (n=6), osteoarthritis and other chronic joint-related conditions (n=5), skin or leg ulcers (n=5), and chronic knee pain (n=2). Strong evidence was identified for the use of topical diclofenac and topical ibuprofen in the treatment of acute soft tissue injuries or chronic joint-related conditions, such as osteoarthritis. Evidence also supports the use of topical lidocaine in the treatment of postherpetic neuralgia and diabetic neuropathy. Currently, limited evidence is available to support the use of other topical analgesics in acute and chronic pain.

Section snippets

Methods

A MEDLINE/PubMed search, covering the period from inception through August 2011, was conducted using the keywords topical analgesic AND chronic pain OR acute pain OR neuropathic pain. The keyword postoperative pain was not included in the search, which largely restricted the search to acute pain conditions other than postoperative pain. In addition, the search was restricted to English-language articles describing individual clinical trials (not reviews of published clinical trials) in humans

Study Identification

The literature search identified a total of 92 articles, of which 65 were eligible for inclusion (Figure).29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92 A total of 27 articles were excluded: 7 articles93, 94, 95, 96, 97, 98, 99 described studies in which the analgesic was not administered

Discussion

Topical formulations of a variety of analgesics have been studied for the treatment of diverse indications (Supplemental Table). However, many of the published studies were small, and studies involving patients with chronic pain were often of short duration. NSAIDs are among the most commonly prescribed drugs throughout the world,124 and hence, it is not surprising that topical formulations of these agents have been studied more widely than topical formulations of other agents. The available

Conclusion

Topical analgesic therapy using NSAIDs or lidocaine has an important place in the management of acute and chronic pain conditions and warrants further study.

Acknowledgments

Technical editorial and medical writing support for the preparation of this article was provided by Karamarie Fecho, PhD, and Synchrony Medical, LLC, West Chester, Pennsylvania.

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    Grant Support: Funding for this study was provided by Mallinckrodt Inc, a Covidien company, Hazelwood, Missouri.

    Potential Competing Interests: Dr Argoff discloses the following relationships: Boehringer Ingelheim GmbH (consultant); Covidien (consultant); Depomed Inc (consultant, speakers bureau); Eli Lilly and Company (grant/research, consultant, speakers bureau); Endo Pharmaceuticals (grant/research, consultant, speakers bureau, investigator); Forest Laboratories Inc (grant/research, consultant, speakers bureau, investigator); Gruenenthal (consultant); Jazz Pharmaceuticals plc (consultant); King Pharmaceuticals Inc (consultant); NeurogesX Inc (grant/research, consultant, speakers bureau, investigator); Nuvo Research Inc (consultant); Pfizer Inc (grant/research, consultant, speakers bureau, investigator); PriCara Division of Ortho-McNeil-Janssen Pharmaceuticals Inc (consultant, speakers bureau); Shinoghi Pharmaceuticals (consultant); and Sanofi US (consultant).

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