Topical analgesics

Developed to provide symptomatic pain relief without systemic adverse events seen with oral or parenteral analgesics.

Can produce clinically effective drug concentrations at a peripheral site of injury or inflammation without high systemic concentrations of the drug.

The lidocaine patch is among the most commonly used topical analgesic agents.
Lidocaine patch at a dose of 1.8% or 5%, is approved for postherpetic neuralgia and is recommended for peripheral neuropathic pain.
These patches are applied of the sites of paying for up to 12 consecutive hours per day, and have a few side effects but may cause skin irritation.
Capsaicin is the active ingredient in Chile peppers, and activates the transit receptor potential vanilloid channel of small peripheral sensory nerves.
Capsaicin effective by  repeated application is thought  to occur through desensitization and the temporary reduction in the number of pain fibers in the skin.
Capsaicin 8% patch is the second nine treatment for peripheral neuropathic pain such as post herpetic neuralgia and painful polyneuropathy, but has no effectiveness in other pain conditions.
10.6 patients need to be treated with Capsaicin for one patient to benefit.
Capsaicin Local side effects include skin reactions and discomfort on initial application.
Capsaicin 8% patches are applied by avhealthcare professional and the treatment can be repeated every three months.
There is no good evidence that weaker, over the counter preparations of menthol, Capsaicin  or methyl salicylate have an effect on pain.
Botulinum toxin A. given subcutaneously in the region of pain is a third line treatment for peripheral neuropathic pain.

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