What is the recommended treatment for back pain using topical diclofenac 10% in PLO (Polyethylene Oxide) gel?

From the Guidelines

For back pain, topical diclofenac 10% in PLO gel should be applied by massaging a small amount (approximately 2-4 grams) onto the painful area 3 times daily, as suggested by the study 1. This treatment approach is based on the principle of acting locally to relieve pain with minimal systemic absorption, which is beneficial for reducing the risk of side effects associated with oral NSAIDs. The application of the gel should be to clean, dry skin, and the area should be allowed to dry before covering with clothing. Patients should wash their hands thoroughly after application unless they are treating their hands. It's essential to note that diclofenac works by inhibiting cyclooxygenase enzymes, which reduces prostaglandin production and thereby decreases inflammation and pain at the application site. Some key considerations for the use of topical diclofenac include:

• Potential for mild skin irritation, redness, or itching at the application site
• Contraindications in patients with known NSAID allergies, aspirin-sensitive asthma, or during the third trimester of pregnancy
• The need for medical consultation if pain persists beyond two weeks of regular use or worsens Given the information from the studies 1, it's clear that NSAIDs, including topical formulations like diclofenac, are effective for pain relief but must be used judiciously, considering the potential risks, especially gastrointestinal and cardiovascular risks. However, the specific guidance for topical diclofenac 10% in PLO gel application frequency and dosage is most directly informed by the study 1, which suggests application 3 times daily. This approach aligns with the goal of minimizing systemic exposure while maximizing local therapeutic effects, thus potentially improving the quality of life for patients with back pain by reducing their discomfort with fewer side effects compared to systemic NSAID use.

From the Research

Topical Diclofenac 10% in PLO Gel for Back Pain

• The recommended treatment for back pain using topical diclofenac 10% in PLO (Polyethylene Oxide) gel is not directly stated in the provided studies, but we can look at the available evidence for guidance.
• A study on the efficacy and safety of diclofenac + capsaicin gel in patients with acute back/neck pain found that topical non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used to reduce pain and inflammation with fewer systemic side effects and drug interactions compared with oral NSAIDs 2.
• Another study evaluated the effectiveness and safety of diclofenac epolamine topical patch 1.3% for the treatment of acute pain due to back strain, and found that patients experienced well-tolerated relief for acute pain due to back strain, with ≥ 85% of patients and their investigators expressing satisfaction with the treatment 3.
• However, a study on the in vitro permeability, irritability, and release evaluation of commonly used topical diclofenac gel preparations (1%, 5%, and 10%) found that higher diclofenac concentrations in compounded topical preparations may lead to significantly higher blood concentrations as compared to commercially available products, which in turn may also lead to serious side effects 4.
• Based on the available evidence, it is essential to carefully evaluate the benefits and risks of using topical diclofenac 10% in PLO gel for back pain, and to consider the potential for increased systemic exposure and adverse events, particularly in elderly patients or those with pre-existing medical conditions 5, 2, 4.

Dosage and Administration

• The dosage and administration of topical diclofenac 10% in PLO gel for back pain are not explicitly stated in the provided studies.
• However, a study on the in vitro permeability, irritability, and release evaluation of commonly used topical diclofenac gel preparations (1%, 5%, and 10%) found that the release profiles of all tested preparations followed the Higuchi model, and that the percentage absorption (%abs) from different formulations ranged from 11.18% to 19.6% depending on the gel base 4.
• It is crucial to follow the recommended dosage and administration guidelines for topical diclofenac 10% in PLO gel, and to monitor patients for potential adverse events, particularly when using higher concentrations or frequent applications 5, 2, 4.

Safety and Efficacy

• The safety and efficacy of topical diclofenac 10% in PLO gel for back pain are not fully established in the provided studies.
• However, a study on the efficacy and safety of diclofenac + capsaicin gel in patients with acute back/neck pain found that capsaicin alone and capsaicin + diclofenac showed superior benefit compared with placebo, but diclofenac alone demonstrated efficacy comparable with placebo 2.
• Another study evaluated the effectiveness and safety of diclofenac epolamine topical patch 1.3% for the treatment of acute pain due to back strain, and found that patients experienced well-tolerated relief for acute pain due to back strain, with ≥ 85% of patients and their investigators expressing satisfaction with the treatment 3.
• It is essential to carefully evaluate the benefits and risks of using topical diclofenac 10% in PLO gel for back pain, and to consider the potential for increased systemic exposure and adverse events, particularly in elderly patients or those with pre-existing medical conditions 5, 2, 4.