From the Guidelines
I recommend using Voltaren (diclofenac sodium) gel for the patient's elbow pain related to pseudogout. The patient can apply a thin layer of Voltaren gel to the affected elbow areas 3-4 times daily, massaging it gently into the skin until absorbed. Each application should use approximately 2-4 grams of gel (about the size of a quarter to half-dollar). The patient should wash hands after application unless the hands are the treatment area. Voltaren would be most appropriate because it's a topical NSAID that can reduce inflammation associated with crystal arthropathy in pseudogout, addressing both pain and the underlying inflammatory process. Unlike Bengay which primarily works through counterirritant effects, Voltaren provides anti-inflammatory benefits by inhibiting prostaglandin synthesis locally at the site of pain. Capsaicin cream could cause significant burning sensation, especially initially, and lidocaine would only provide temporary numbing without addressing inflammation. The patient should be advised that improvement may take several days of consistent use, and to avoid sun exposure to treated areas.
Some key points to consider:
- The patient's history of pseudo gout and current complaint of elbow pain suggests an inflammatory process that can be addressed with a topical NSAID like Voltaren 1.
- The use of Bengay at home has provided some relief, but its counterirritant effects may not be sufficient to address the underlying inflammation, making Voltaren a more suitable option.
- Capsaicin cream and lidocaine ointment are alternative options, but their potential side effects and limited benefits make them less desirable in this case 1.
- It is essential to follow the recommended dosage and application instructions for Voltaren to minimize potential side effects and maximize its therapeutic benefits.
Overall, the use of Voltaren gel is a reasonable and evidence-based approach to managing the patient's elbow pain related to pseudogout, considering its anti-inflammatory properties and potential to improve the patient's quality of life.
From the FDA Drug Label
Active Ingredient Purpose Capsaicin 0.035% External Analgesic The patient is complaining of elbow pain, and capsaicin cream is an external analgesic.
- Capsaicin cream may be used to help with pain relief. Since the patient has a history of pseudo gout and uses bengay at home with some relief, capsaicin cream could be considered as an option for pain management 2.
From the Research
Treatment Options for Pseudogout
The patient is experiencing elbow pain due to pseudogout and has found relief with Bengay at home. The pharmacy has suggested capsaicin cream, lidocaine ointment, or voltaren as potential treatment options.
- Capsaicin cream: There is no direct evidence in the provided studies to support the use of capsaicin cream for pseudogout.
- Lidocaine ointment: There is no direct evidence in the provided studies to support the use of lidocaine ointment for pseudogout.
- Voltaren: Voltaren is a nonsteroidal anti-inflammatory drug (NSAID), which may be effective in relieving pain and inflammation associated with pseudogout, as suggested by studies on gout treatment 3, 4, 5, 6.
Pseudogout Treatment
Pseudogout acute treatment is similar to acute gouty arthritis treatment, which includes the use of anti-inflammatory medications such as NSAIDs 3. However, there is no standard regimen for long-term chronic therapies of pseudogout 3. Colchicine may be used as a prophylactic agent in managing recurrent attacks of pseudogout 7.
Gout and Pseudogout Management
Gout and pseudogout are crystalline arthropathies that require prompt treatment to relieve short-term suffering and prevent long-term complications 3, 4, 5. The diagnosis of gout and pseudogout can be made using clinical prediction rules, and arthrocentesis may be performed to confirm the diagnosis 5. Treatment of gout and pseudogout should be individualized based on the patient's medical history, comorbidities, and response to treatment 3, 4, 5, 7.