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Topical Pain Medications: Benefits, risks

Updated on April 23, 2017

Topical medications: Do they work

There are several prescription topical medications that are available today. These medications are typically applied locally to a painful area. Topical medications, however, are generally largely experimental in nature. Research is ongoing to evaluate the effectiveness of many topical agents and there are very few trials that currently support the efficacy for topical medications. In general, topical medications are more commonly prescribed for neuropathic pain (nerve pain), but they are only recommended/prescribed when oral medications are not tolerated or have been ineffective. The advantages of topical medications is that they are not ingested and metabolized, so they do not provide the typical side effect profiles that common oral medications provide. There are also no risks of drug interactions and there is no need to adjust the dosage, or titrate.

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It is quite typical for topical medications to be combined to include different classes of medications to provide effects. The most common topical medications include anti-inflammatory medications, opioids, local anesthetics, cannabinoids, anti-depressants, and muscle relaxants. However, again, there is very little research in support of combination medications. The prescription of topical medications can become quite complex when combination medications are used, as it requires knowledge of the specific analgesic effect of each separate medication and how it will be useful in individual cases. When referring to topical analgesics, this does not include the class of analgesic medications that utlize a transdermal means to enter the body. For example, the medication Duragesic, a potent opioid analgesic, is applied topically with a patch, but it is not classified as a topical medication because it is actually absorbed transdermally and enters the systemic supply. Whereas, topical analgesics, only work locally where they are applied just under the skin.

Local anesthetics, like lidocaine, are used commonly for dental procedures, and lidocaine is also used as a numbing agent for many injections. This medication can be applied topically and is most recommended when there is nerve pain. However, oral medications should be tried first. Lidoderm is a topical patch applied to the skin that delivers lidocaine locally. The FDA notified the public in 2007 of a potential hazard of the use of topical lidocaine, especially when it is applied to large areas and left on for a long time, this can lead to systemic exposure and effects.

Capsaicin is a topical analgesic medication that can be applied locally and is only recommended is oral medications cannot be tolerated. It is mostly recommended for nerve pain, but there are also studies that have found a positive effect on arthritis, fibromyalgia and back with this agent. It is mostly considered to be experimental, however, at large doses.

Muscle relaxants have been used as topical medications and are being researched to evaluate for possible positive effects. Baclofen, a muscle relaxant medication that is commonly prescribed orally to address painful muscle conditions, is currently in a Phase III study at the Institute of Health, in which it is being studied for its possible benefit for chemotherapy related nerve pain. However, it is still experimental and there is actually no research that has proven a positive effect with topical muscle relaxants. No other muscle relaxant medications are proven effective or beneficial for topical use.

In general, it appears that topical medications do not offer a very promising alternative to oral medications to treat pain related to arthritis, muscle spasm, nerve problems and injury. Most physicians who specialize in orthopedics, physcial medicine and rehabilitation and pain management, however, commonly use topical medications to supplement the oral medications prescribed in hopes that the topical medication will help the patient to decrease the need for reliance on oral medications to address pain. Nonetheless, treatment response is variable, and not proven, thus, topical agents do not provide a reliable alternative to oral medications.


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    • Heather Says profile image

      Heather Rode 5 years ago from Buckeye, Arizona

      With your education and experience you are a wealth of knowledge! I can't wait to read more of your hubs. Great info. Thanks :)