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Topical (locally applied) agents

Various drugs can be used by application to the skin for pain management. The main groups that are useful include Local Anaesthetics , Non-steroidal anti-inflammatories (NSAID’s ) and a drug called Capsaicin.

Topical anti-inflammatories can be useful for some pains particularly those from joints or other sources that are close to the skin. The drug diffuses through the skin and builds up in the tissues. 

Capsaicin is one of the active ingredients in chilli peppers. People who like spicy food will know that with repeated exposure to hot curries they can tolerate hotter and hotter ones. This is because the capsaicin is taken up into the nerve endings and carried back to the central nervous system and there reduces the release of chemicals that transmit pain. Capsaicin used for pain works in part in the same way, and with regular frequent thin application it can help to reduce pain. It is often used in shingles pain, and can also be used for other pains such some forms of arthritis and nerve pains.

Treatment with capsaicin cream should be 4 times daily at least to start with, has to continue for 6 weeks for permanent effect. It is licensed for use in post herpetic neuralgia, and has an advantage of being generally safe as long as it is not put near the eye. Care ought to be taken to remove excess from hands after use before touching anywhere sensitive.

There is increasing experience with a patch impregnated with a very strong 8% capsaicin concentration, trademarked Qutenza.  This may be of use in some nerve pains in the skin.  Because of its strength, this treatment is not suitable for application by the patient, and is applied under controlled circumstances in hospital by our specialist nurses.  Our Pain Service's information sheet on this treatment can be downloaded from this link.

Local Anaesthetics can sometimes be used by local application, but most preparations can be of limited use and be fiddly to use. There is early experience with the use of a Lidocaine patch, and this is discussed further here.

You may have heard about the use of strong opiates, Fentanyl or Buprenorphine, as patches applied to the skin. This is discussed in the Opioids section of this site.

 

Further information for professionals

Some more detail, of more interest to medical professionals, is given on this linked page.

 

  

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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
email: pain.webmaster[at]glos.nhs.uk

Page updated 22/6/2016