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.
Abbreviations and Acronyms:
AE (adverse event), AHN (acute herpetic neuralgia), NSAID (nonsteroidal anti-inflammatory drug), PHN (postherpetic neuralgia)References
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Article Info
Footnotes
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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© 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
