Topical Analgesic

Aka: Topical Analgesic

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II. Cost

  1. Topical Analgesics are expensive (even for generics) and often not covered by insurance
  2. As of 2015, monthly costs may range from $100 Lidoderm patches to >$1500 for Pensaid (Diclofenac Solution)
  3. Least expensive options
    1. Lidocaine 4% patches (e.g. Lidocare 4%) - OTC
    2. Capsaicin

III. Preparations

  1. Topical NSAID: Diclofenac
    1. Diclofenac Solution (Pensaid 1.5%)
    2. Diclofenac Gel (Voltaren Gel 1.5%)
    3. Diclofenac Patch (Flector Patch)
  2. Lidoderm Patch (4 to 5% Lidocaine Patch)
    1. Limited to 12 hour application per day
    2. Cost >$100 per 30 generic patches (2015)
    3. However, OTC Lidocaine 4% patches (e.g. Lidocare 4%) cost only $3 per patch
      1. Unclear efficacy compared with 5% patches
  3. Capsaicin (0.025% and 0.075%)
    1. Primarily used for Postherpetic Neuralgia
    2. Also used in hand, hip and Knee Osteoarthritis
    3. Initial burning may be poorly tolerated, and may take 4 weeks to show effect
  4. Compounded topicals
    1. Some pharmacies compound Toradol, Gabapentin (evidence is lacking)
  5. Transcutaneous electrical nerve stimulation (TENS)
    1. TENS evidence is variable, but may offer benefit as an adunct to other measures

IV. References

  1. (2016) Presc Lett 23(6):35
  2. (2015) Presc Lett 23(1):2
  3. Stanos (2007) J Pain Symptom Manage 33(3): 342-55 +PMID:17349504 [PubMed]

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