Topicals for pain relief

Check out this 8 minute video update on use of topicalsfor pain management on MedScape today. Dr. Charles Argoff, Professor of Neurology at Albany Medical College, shares updates in research from the American Academy of Pain Management meeting that took place in September. In the video, Dr. Argoff discusses various types of topical agents that have been tested for relief of acute and/or chronic pain. A topical agent, he points out, has a more local effect, with less systemic uptake than an oral medication, and ideally less side effects because of the decrease in general uptake.

Some of the topicals are anti-inflammatory, such as Voltarin, which can be used for osteoarthritis. Pennsaid and the Flector patch also have an anti-inflammatory action. Pennsaid has research to support its use for knee osteoarthritis, and the Flector patch is applied for muscle sprain/strain type injuries.The lidocaine patch, which has FDA approval for post-herpetic neuralgia, has also been reported to be useful for chronic musculoskeletal pain or complex regional pain syndrome. The Qutenza patch (with 8% capsaicin, extracted from chili peppers) has been demonstrated to be helpful for reducing pain of post-herpetic neuralgia. This patch works on a specific receptor that is in the skin, thereby reducing local pain. Whereas the lidocaine patch can be applied by the patient, the Qutenza patch must be applied carefully in an office setting.

Dr. Argoff concludes that the skin (and therefore topical, local applications to skin in painful areas) may be "...far more important than we ever thought in helping people control their pain." This is due to the important role that skin (an organ) plays in the initiation, maintenance, and modulation of the pain experience.

So how can topicals be useful to our patients with pelvic pain?When working as a team with medical providers, we can advocate for our patients to have the option of trying some pain patches over tissue that can tolerate such an application. Perhaps coccygeus pain, ischial bursitis pain, or other sites of neuropathic pain in the inguinal area, gluteal regions, or abdominals would respond favorably to the application of topicals. An example of research supporting use of topicals is thisCanadian studythat describes the benefits of a mixture of amitriptyline, ketamine, and lidocaine for neuropathic pain caused by radiation dermatitis. As with most modalities for pelvic pain, we need more research.In the world of pelvic pain, any option that assists the patient in healing the pain experience can be positive.