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30 “НАШЕ ЖИТТЯ”, ЖОВТЕНЬ 2010 TOPICAL ANALGESICS by Ihor Magun, MD, FACP Th e demand for striking a balance between targeting pain relief with minimal side effects has fueled a new medical paradigm — pain management that focuses on delivery of pain relief in a more targeted, localized approach. One reason for this evolution is the f rustrating problem of analgesics taken orally or by injection working well , while at the same time causing systemic adverse effects. These limitations created a largely unmet need and provided an excellent window of opportunity to expand and develop topica l agents as an alternative. There has been striking progress in the logistics of delivery of localized medication. A b - sorp tion through the skin barrier has been improved by the use of penetration enhancers as well as a choice of the compound selected. Ad hesive mechan - isms have also been perfected. H eat - activated patches have been very helpful. The heat generated increase s blood circu - lation and provides a warm, comfort ing feeling. The patches are now designed so they can be placed on various parts of the body with site - appropriate adhesion. The over - the - counter cream C apsaicin , which has been recommended for treatment of osteoarthritis (not rheumatoid) , is actually an extract of chili peppers and is used on the knees and/or hands to manage chronic pain . Th e mechanism of action is pain desensitization . Effective u se of this cream requires repeated applications , and it can cause a burning sensation in the early stages of treatment before it reaches its targeted goal of pain desensitization . Continued use is n ec essary to maintain its affect. The makers of Tylenol ha ve recently released Precise, an ointment that can be used to alleviate the pain associated with arthritis, sprains, bruises , and strains. Precise is a combination of menthol and methyl salicylate an d provide s loca - lized warmth and localized pain relief. The mo st commonly prescribed prescription product for localized nerve pain is the lidocaine patch. Although it has only been approved by the FDA for use in managing neuropathic pain from shingles (her pes zoster), it has also been used to relieve (essentially through numbing) pain from a neuropathic cause s besides shingles . One t opical prescription anti - inflammatory medication is a gel called Voltaren . A pproved for osteoarthritis of the hands and knees , it is applied four times daily. Studies comparing the efficacy of oral agents vs. this topical gel suggest they are equivalent, except for the absence of systemic side effects when the gel is used. Several caveats regarding these topical agents. Despite the fact that these are topical, these medications do get absorbed into the body and can s till pose a problem with side effects — albeit to a lesser degree than the commensurate oral version. Persons allergic to any of the ingredients will need to avoid us in g the topical analgesics, just as they would with any oral medication. The topical analgesics should be applied only to intact skin and the area where the analgesic is applied should be frequent ly monitor ed for signs of irritation (for example, a rash) . If anything just does not seem right, it is best to stop using the analgesic and remove the application or patch. This article included only a brief overview of what is currently available for pain management . Many new medications can be compounded in variou s pharmacies . There is also a separate set of medications which are not topical analgesics, but provide a sustained amount of medication for systemic needs — these include estrogen supple - ments, narcotic patches, overactive bladder patches, motion sickness p atches, nicotine patches, blood pressure control patches , and testosterone patches. Delivery systems of medications that have a targeted approach to dealing with pain are just the beginning of what is in store. N ew advances are being explored and many will certainly be welcome additions to the arsenal used to fight pain and other ailments. Видання C оюзу Українок A мерики - перевидано в електронному форматі в 2012 році . A рхів C У A - Ню Йорк , Н . Й . C Ш A.
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