What is the treatment for pain using topical cream?

From the Guidelines

Topical capsaicin cream is the most effective treatment for pain, particularly for mild to moderate pain associated with osteoarthritis or neuropathic pain, as it depletes substance P, a pain transmitter, and has been shown to have a moderate effect in reducing pain 1. When considering treatment options for pain using topical creams, it's essential to evaluate the available evidence.

Key Points to Consider

• Topical capsaicin cream has been found to be effective in reducing pain associated with osteoarthritis and neuropathic pain 1.
• The use of capsaicin cream may require continuous usage for 2 to 4 weeks before a therapeutic effect is experienced 1.
• Adverse events associated with capsaicin cream are typically localized to the site of application and may include burning or stinging 1.
• Other topical options, such as menthol-based creams and diclofenac gel, may also be effective for mild to moderate pain 1.
• Prescription options, including compounded creams containing combinations of medications like lidocaine, ketamine, gabapentin, and amitriptyline, may be considered for more severe pain 1.

Application and Precautions

• Apply a thin layer of topical cream to the affected area 3-4 times daily 1.
• Wash hands thoroughly after application 1.
• Avoid applying topical creams to broken skin 1.
• Do not cover the affected area with tight bandages unless directed 1. By considering these key points and following the recommended application and precautions, topical capsaicin cream can be an effective treatment option for pain, minimizing systemic side effects compared to oral medications.

From the FDA Drug Label

Apply diclofenac sodium topical solution exactly as your healthcare provider tells you. Only use diclofenac sodium topical solution to treat pain from osteoarthritis in your knee or knees. Apply diclofenac sodium topical solution on clean, dry skin that does not have any cuts, infections or rashes. Use diclofenac sodium topical solution two times a day on your knee or knees as prescribed The treatment for pain using topical cream is to apply diclofenac sodium topical solution two times a day on the affected knee or knees as prescribed by a healthcare provider. The solution should be applied on clean, dry skin without any cuts, infections, or rashes. It is only approved for use on the skin to treat pain from osteoarthritis in the knee or knees 2.

From the Research

Treatment for Pain using Topical Cream

The treatment for pain using topical cream involves the use of various topical analgesics, including capsaicin, lidocaine, and NSAIDs.

• Topical capsaicin is used to treat pain from a wide range of chronic conditions, including neuropathic pain 3, 4, 5.
• The application of capsaicin to the skin causes enhanced sensitivity to noxious stimuli, followed by a period with reduced sensitivity and, after repeated applications, persistent desensitisation 3, 4.
• High-concentration capsaicin (8%) has been shown to be efficacious in the treatment of postherpetic neuralgia, painful diabetic peripheral neuropathy, and HIV-neuropathy 4, 6, 5.
• Low-concentration capsaicin (< 1%) may not have meaningful effects beyond that found in placebo creams, with local skin irritation being a common side effect 3, 7.
• Topical lidocaine has been widely studied and found to reduce pain in patients with postherpetic neuralgia 6.
• Topical NSAIDs, such as diclofenac and ketoprofen, have been found to be useful in treating acute musculoskeletal pain syndromes and show some efficacy in treating hand and knee osteoarthritis 7, 6.

Efficacy and Safety of Topical Analgesics

• The efficacy of topical analgesics varies, with some formulations showing good pain relief and others having limited efficacy 7, 6.
• Local skin reactions are a common side effect of topical capsaicin, but are usually tolerable and attenuate with time 3, 4, 5.
• Systemic adverse effects are rare with topical analgesics, making them a relatively benign treatment option for chronic pain conditions 7, 6.
• The exact formulation of the topical analgesic used is critically important in determining its efficacy, with some formulations showing better results than others 7, 6.