Chronic Pain Management for Providers

Introduction

Chronic pain can be very difficult to manage in many patients. Many of the traditional oral drugs used for pain treatment, such as opioids, NSAIDs, and anticonvulsants, can have unwanted systemic side effects. These classes of medications, among others, can be just as effective in managing pain when used topically. Using a multimodal approach to treating symptoms of chronic pain has also been shown to be efficacious, which can be easily accomplished using a topical formulation.

Treatment Options

Classes of medications that can be used topically include: NSAIDs, Alpha II Agonists, AMPA-Na+ Channel Blockers, GABA Agonists, NMDA-Ca2+ Channel Blockers, Tricyclic Antidepressants.

Advantages:

• Avoid first pass hepatic metabolism
• Avoid GI tract
• May improve compliance
• Increased drug concentration at site of pain
• Decreased systemic side effects

Disadvantages:

• Most common side effect is rash
• May not be suitable for large areas
• Absorption may vary from patient to patient depending on the stratum corneum barrier