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Topical Approaches to Pain Management A


Haidita Celestine


pplying pain relief treatment directly where it hurts is not a new practice. Healers throughout human history and in every culture have applied


medicines directly to the source of pain. One of the old- est, and the largest, complete medical documents ever discovered, the 3500-year-old Ebers Papyrus, includes poultices, salves, oils and plasters for conditions ranging from Sting of Wasp to Headache. Found in a tomb at Tebes about 1862 and preserved


at the University of Leipzig, it is a miscellaneous collec- tion of extracts and jottings from at least forty sources. Tere is abundant evidence that these sources come from numerous books many centuries older. Spells and incantations are also freely interspersed, as are domestic tips for such things as keeping mice away from clothes. One remedy found in the text is a poultice composed of pieces-of-excrement, Cat’s dung, Dog’s dung, and berries of the Xet plant. Tis apparently would “drive out all the Scurf”. “I can assure you that TPR20 Pain Relief Cream con-


tains no dung of any sort,” says Rowan Hamilton, Direc- tor of Research at Humn Pharmaceuticals of Winnipeg. “What it does contain though, helps us believe in the strength of modern medical pain relievers without the need for powerful pills.” Te most common pharmaceutical approaches to pain


today are oral medications (pills). With this approach, come regular side effects including gastrointestinal com- plications, liver disease, kidney disease and potential de- pendency. Canadian consumers are increasingly wary of such potential risks and are looking for a less invasive approach that can be provided by topical analgesics. Te type used successfully for centuries; provided of course that they don’t contain dung. In our own time and culture a new understanding of


pain treatment is emerging from research and patient studies. It is increasingly pointing to topical prepara- tions as a viable delivery mechanism for pain relief medication. Te forms they take are creams, gels, liquids and patches. Teir object is to apply pain relief where it hurts, when it hurts. Tis may be one of the most im- portant recent developments in the treatment of pain – even if it is a centuries old practice. Modern pain medicine as we know it dates from the


development of chemistry in the nineteenth century. Salicylic acid from willow bark was refined into acetylsal- icylic acid in Germany and marketed in 1899 as acetyl- salicylic acid. Tis was the first of what are now known as Non Steroidal Anti-inflammatory Drugs (NSAIDs) and began a revolution with the addition of acetaminophen / paracetamol in 1956 and ibuprofen and indomethacin in


1962. Te products were all pills and still are. Te other major pain medication derives from the Opium poppy. Synthesized from the raw opium, morphine went on sale in 1827. Heroin from the same source became available in 1874. Tese two basic medicine groups are still with us.


Pharmaceutical chemistry has refined and developed synthetic derivatives in the search for more powerful and patentable compounds. Despite increasing evidence of side effects and adverse reactions, they have become the accepted standard for pain medication. Topical prep- arations were largely lost to history; today they appear so new to us that the first topical NSAID was only ap- proved by the US FDA in 2007. Topical therapies act locally rather than through sys-


temic absorption and distribution in the way that injec- tions or pills are intended to act. Topical use of analgesics and anti-inflammatories is an effective and increasingly popular approach that avoids gastrointestinal irritation and the metabolic degradation associated with oral ad- ministration. Tey make possible, in a cream form, the use of local anaesthetic compounds such as Lidocaine, well known to the public as an injected anesthetic in the dentist’s chair, which actually block the transmission of


pain in the nerves. Topical approaches can be effective at far lower doses


than oral pain medication. Tey go where they are need- ed, when they are needed, and only need to act on the site of pain itself. Tey bypass the digestive tract and liver minimizing side effects, drug interactions and or- gan toxicity. Tere are generally less dose restrictions for topical preparations than oral medications and they typically act much faster than oral medications having their effect before a pill has even reached the stomach. Tey are effective for pains that would not normally


be treated with regular pain medications. Tese include sunburn, insect bites, poison ivy and other plant irri- tants, minor burns, blisters, hemorrhoids, skin condi- tions, even shingles. Te direct action of topical creams makes them ideal for muscle and joint pain, aches and sprains. Both the American Geriatric Society the Cana- dian Pain Society recommend topical lidocaine for neu- ropathic pain like shingles. A study undertaken by the American Osteopathic As-


sociation showed that nearly half of the population does not believe that pain is something that can be eased with mainstream medications. Topical pain relief can change that belief.


It’s human to fondly remember limbs that provided walks without complaint. It’s also human to dislike being reminded about it by a rude knee yelling for relief.


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