From the FDA Drug Label
Active Ingredient Purpose Capsaicin 0.035% External Analgesic Directions Adults and children 18 years of age and older: Apply a thin film of cream to affected area and gently rub in until fully absorbed. Unless treating hands, wash hands thoroughly with soap and water immediately after application. For best results, apply 3 to 4 times daily.
The recommended topical cream for pain relief is capsaicin (TOP). Key points to consider are:
- Application: Apply a thin film to the affected area 3 to 4 times daily.
- Age restriction: Approved for adults and children 18 years of age and older.
- Caution: Wash hands thoroughly after application unless treating hands 1 1.
From the Research
Topical analgesic creams containing diclofenac (1-3%), lidocaine (5%), or menthol-based formulations are recommended for pain relief in elderly patients with rib fractures, as they minimize systemic side effects and provide effective pain relief. These creams work best as part of a multimodal pain management approach that may include oral medications like acetaminophen (up to 3000mg daily in divided doses) for elderly patients. Diclofenac works by reducing inflammation at the site of injury, while lidocaine blocks pain signals and menthol creates a cooling sensation that distracts from pain. For elderly patients, topical treatments are particularly beneficial as they minimize systemic side effects compared to oral NSAIDs, which can cause gastrointestinal bleeding, kidney problems, and cardiovascular issues. However, even topical preparations should be used cautiously in patients with compromised skin integrity, and the area should be monitored for irritation or allergic reactions. Patients should consult their healthcare provider before starting any treatment, especially if they have other medical conditions or take multiple medications.
The use of regional anesthesia techniques, such as epidural analgesia, paravertebral block, and nerve blocks, may also be effective in managing pain associated with rib fractures, as discussed in studies 2, 3. However, these techniques may have limitations and contraindications, and their use should be individualized based on the patient's specific circumstances. In contrast, topical analgesic creams are a relatively safe and effective option for pain relief in elderly patients with rib fractures.
It is essential to note that the management of pain in elderly patients with rib fractures requires a comprehensive approach that takes into account the patient's overall health status, medical history, and potential interactions with other medications. As highlighted in studies 4, 5, 6, a multimodal pain management approach that includes a combination of pharmacological and non-pharmacological interventions can help to optimize pain relief and minimize adverse effects.
In terms of specific application, a thin layer of topical analgesic cream should be applied to the affected area 3-4 times daily, gently massaging until absorbed, for up to 7-10 days or as directed by a healthcare provider. Patients should be monitored for signs of irritation or allergic reactions, and the treatment plan should be adjusted as needed to ensure optimal pain relief and minimize adverse effects.