Abstract
The comprehensive treatment of pain is multidimodal, with pharmacotherapy playing a key role. An effective therapy for pain depends on the intensity and type of pain, the patients’ age, comorbidities, and appropriate choice of analgesic, its dose and route of administration. This review is aimed at presenting current knowledge on analgesics administered by transdermal and topical routes for physicians, nurses, pharmacists, and other health care professionals dealing with patients suffering from pain. Analgesics administered transdermally or topically act through different mechanisms. Opioids administered transdermally are absorbed into vessels located in subcutaneous tissue and, subsequently, are conveyed in the blood to opioid receptors localized in the central and peripheral nervous system. Non–steroidal anti–inflammatory drugs (NSAIDs) applied topically render analgesia mainly through a high concentration in the structures of the joint and a provision of local anti–inflammatory effects. Topically administered drugs such as lidocaine and capsaicin in patches, capsaicin in cream, EMLA cream, and creams containing antidepressants (i.e., doxepin, amitriptyline) act mainly locally in tissues through receptors and/or ion channels. Transdermal and topical routes offer some advantages over systemic analgesic administration. Analgesics administered topically have a much better profile for adverse effects as they relieve local pain with minimal systemic effects. The transdermal route apart from the above-mentioned advantages and provision of long period of analgesia may be more convenient, especially for patients who are unable to take drugs orally. Topically and transdermally administered opioids are characterised by a lower risk of addiction compared to oral and parenteral routes.
Highlights
Pain is defined as a subjective phenomenon that is associated with actual or potential damage to tissues
Capsaicin used in the form of ointment with a concentration below 1% is effective in pain syndromes such as syndrome of burning mouth, neuropathic face pain, trigeminal neuralgia, reflex sympathetic dystrophy, neuropathy in the course of HIV, osteoarthrosis, Guillain–Barré syndrome, fibromyalgia, and persistent postoperative pain
There has been a continuous increase in knowledge and understanding of the pathophysiology of pain and its treatment
Summary
Pain is defined as a subjective phenomenon that is associated with actual or potential damage to tissues. Is common and the skin with intact nervous systems, and neuropathic pain, which is associated with damage or that mixed (both nociceptive and neuropathic) pain syndromes are present, for example in cancer disease the somatosensory nervous system, regardless of possible causes. Several to groups of analgesics are typically management that is comprised of pharmacotherapy, along with non–pharmacological available,require and the general rule is to combine drugs with different modes of analgesic action, which measures. An important factor in choosing optimal route ofstatus analgesic administration is the acceptance of patients. There are several routes of analgesics administration: sublingual, intranasal, inhaled, subcutaneous, intravenous, administration: sublingual, buccal, intranasal, inhaled, subcutaneous, intramuscular, oral, rectal, intramedullary, intrathecal, transdermal and intravenous, topical.
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