Topical Analgesics - information for professionals
Capsaicin is available in two formulations, 0.025% (Zacin) and 0.075% (Axsain). It is best used very thinly and four or so times a day: thick application does not work better and sometimes leads to the formation of a dust of the dried cream that can be irritant to the eyes and elsewhere. It is wise to warn the patient to wash the hands carefully after application of the cream particularly before touching the eyes – or going to the toilet!
Capsaicin was reviewed on the Bandolier site.
We are gaining early experience with a new formulation of capsaicin, Qutenza. This is a much stronger formulation of capsaicin as an 8% impregnated patch which is applied under strictly controlled circumstances in the clinic after local anaesthesia of the skin.
Topical Local Anaesthetics - this includes the impregnated lidocaine patch Versatis, whose use is discussed on this patient page. Other topical preparations such as EMLA cream and Ametop are not really suitable for chronic use.
Topical Nonsteroidals are available in preparations of a number of agents. Various references suggest a variety of them are best: essentially there is not much to choose between them. Though the evidence for their efficacy is not enormously strong they can sometimes be useful particularly when the pain source is close to the skin.
Topical opioid preparations are discussed in the opioid pages in this site.
Detailed Bandolier review of topical agents
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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
Page updated 19/02/2016