Stick It to Me: Topical and Transdermal Analgesics at End of Life (524)

Abstract

1.Describe the evidence regarding efficacy and toxicity of topical analgesics, and proposed roles in caring for patients with advanced illness.2.Describe patient- and agent-related variables that affect the selection and use of transdermal opioids (eg., fentanyl and buprenorphine), including equianalgesic conversions and timing considerations when switching to and from a transdermal opioids.3.Given an actual or simulated case of a patient with an advanced illness, assess for the appropriateness of a topical or transdermal analgesic, and recommend dosing and monitoring strategies. Topical and transdermal analgesics are frequently used to provide an opioid-sparing effect, or serve to facilitate analgesic delivery by a non-oral route of administration. However, most practitioners are unaware of the role in therapy for these analgesics. Specifically, practitioners are not clear on the patient- and drug-related variables that influence product selection, and realistic expectations for patient outcomes. Participants in this session will learn about the efficacy and toxicity of topical analgesics including commercially available products such as capsaicin, salicylates, counterirritants, nonsteroidal anti-inflammatory drugs, and lidocaine and compounded topical opioids for wound care pain. By using a case-based active-learning approach, participants will learn which patient scenarios are amenable to topical analgesic therapy. Transdermal opioid therapy (fentanyl and buprenorphine) are not appropriate for every pain patient. Consideration of formulation- and patient-specific variables is key to success. Participants will learn about the appropriate indications for therapy, how to transition to and from these products, how to titrate these products, the impact of patient-specific variables such as fever, low body weight and a rapidly changing pain pattern. Participants will learn the appropriate role of topical and transdermal analgesics through a case-based approach.