A Study Of The Efficacy Of Diclofenac Iontophoresis For Providing Effective Topical Analgesia (original) (raw)
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Pain practice : the official journal of World Institute of Pain
Osteoarthritis (OA) is a chronic degenerative joint disease that is debilitating for many individuals. While oral nonsteroidal anti-inflammatory drugs (NSAIDs) remain a common and effective treatment approach to managing OA, concerns over cardiovascular and gastrointestinal adverse events can potentially limit their use. Various formulations of topical NSAIDs have been shown to provide effective localized treatment with minimal adverse events. A patient perception study was conducted to evaluate patient preference between topical diclofenac sodium gel and that of diclofenac sodium topical solution with the penetration enhancer dimethyl sulfoxide (DMSO). Twenty-four healthy volunteers were randomized and asked to administer one dose of the topical products. Surveys were provided and assessed immediately after application, 5 minutes after application, and after the application had dried to gauge subjects' overall experience with the topical preparation. Overall, each drug's ap...
International journal of pharmaceutical investigation
Newer drug delivery systems such as transdermal patches using pain relieving or modifying agents emerged as a mainstream treatment protocol for management of pain on the outpatient basis. The administration of diclofenac 100 mg in the transdermal patch in the patients having dental pain due to periapical/periodontal infections was evaluated. Ninety patients of either gender, between 18 and 80 years were divided into 3 groups (Group A - oral medication, Group B - transdermal patch, Group C - intramuscular group). Patients at the Dental Department with pain from periapical/periodontal pathologies were explained about the procedure of analgesia. With written consent, 100 mg diclofenac sodium transdermal patches were prescribed to patients who opted their use in pain control for 2 consecutive days. A visual analog scale was provided for all patients assessing the pain intensity during the study. Significant difference in the mean percentage reduction in visual analog scale (VAS) score a...
Life Sciences, 2003
This study compared the antinociceptive effect produced by cathodic iontophoresis of sodium diclofenac close to an arthritic knee-joint in rats with that of systemic application. Arthritic nocifensive incapacitation was induced by LPS (1 Ag) injection into a knee-joint previously (72 h) primed with carrageenan (300 Ag). Diclofenac (0.1, 0.25 and 0.5 mg/kg) given intraperitoneally 1 h after LPS injection caused dose-dependent inhibition of incapacitation. Diclofenac iontophoresis was performed by varying either the current density (0.1, 0.2, and 0.3 mA/cm 2 ) or the duration of application (4, 10, 20 and 30 min) of a polyvinylpirrolydone-hydroxymethylcellulose gel containing 1% sodium diclofenac. A clear, current density-dependent effect was observed for 0.1, 0.2 and 0.3 mA/cm 2 (10 min period), which was similar to the effect observed for the intraperitoneal application of 0.1, 0.25 and 0.5 mg/kg doses. Combining different application periods with different current densities, in a manner that resulted in the same total current (1.6 mA*min) application, did not produce similar therapeutic effects, but the antinociceptive effect was directly proportional to the current density. The ipsilateral iontophoresis (0.25 mA/cm 2 Â 10 min or 0.5 mA/cm 2 Â 4 min) of diclofenac produced an effect significantly greater than the same contralateral application (p < 0.05). In conclusion, our results suggest that the therapeutic effect depends on the current density but not on the application time, and also that the iontophoretic, direct application to the inflamed knee-joint enhances the therapeutic effect probably as a result of the direct delivery of the drug. D
Skin Matters: A Review of Topical Treatments for Chronic Pain. Part Two: Treatments and Applications
Pain and therapy, 2015
In Part One of this two-part series, we discussed skin physiology and anatomy as well as generalities concerning topical analgesics. This modality of therapy has lesser side effects and drug-drug interactions, and patients tolerate this form of therapy better than many oral options. Unfortunately, this modality is not used as often as it could be in chronic pain states, such as that from neuropathic pain. Part Two discusses specific therapies, local anesthetics, and other drugs, as well as how a clinician might use specific aspects of a patient's neuropathic pain presentation to help guide them in the selection of a topical agent.
Topical analgesics for acute and chronic pain in adults
Protocols, 2010
This is the protocol for a review and there is no abstract. The objectives are as follows: To provide an overview of the analgesic efficacy and associated adverse events of topical analgesics (primarily NSAIDs, rubefacients, capsaicin, lidocaine, and opioids) for the treatment of acute and chronic pain in adults. BACKGROUND Description of the condition Topical analgesic drugs are used to treat a variety of painful conditions. Some might be regarded as acute pain (pain lasting less than 3 or 6 months), which are typically strains or sprains, tendonitis, or muscle aches. Others would be regarded as chronic pain, like osteoarthritis of the hand or knee, or certain types of neuropathic pain. Other conditions are more difficult to classify, and here one might include topical opioids for painful cutaneous ulcers, which can be a shorter or longer duration problem. With such clinical heterogeneity it is not surprising that the choice of a topical therapy is determined largely by the condition. Description of the interventions A number of topical analgesics have been tested, and are used. For strains and sprains, the choice would be between topical nonsteroidal anti-inflammatory drugs (NSAIDs) or topical rubefacients. For arthritis, the choice would be between topical NSAIDs, topical rubefacients, or low dose topical capsaicin. For neuropathic pain, the choice would be between topical local anaesthetic (lignocaine/ lidocaine, for example) or high dose topical capsaicin.
Topical Treatment of Peripheral Neuropathic Pain: Applying the Evidence
J Pain Symptom Manage, 2017
Context. Patients with peripheral neuropathic pain (NP) may only achieve partial pain relief with currently recommended first-line oral treatments, which are also associated with systemic adverse events. Topical treatments are currently considered second-or third-line options, but a recent pharmacologic treatment algorithm has called for broader first-line use of these agents. This has highlighted a need to communicate the benefits associated with topical agents, in particular around the efficacy, targeted local action, and limited systemic availability resulting in minimal systemic adverse events and drug-drug interactions. Objectives. This review aims to evaluate the evidence base for topical therapies currently used to treat peripheral NP, discuss the evidence comparing these treatments head-to-head with oral standard of care, and evaluate how they fit into treatment regimens in the ''real world.'' Methods. This is a narrative review. Results. Two topical treatments are currently licensed: lidocaine 5% medicated plaster (post-herpetic neuralgia) and the capsaicin 8% patch (peripheral NP). When compared head to head with the oral standard of care (pregabalin), the lidocaine 5% medicated plaster provided similar relief of pain associated with post-herpetic neuralgia but did not meet the primary predefined criteria for noninferiority. The capsaicin 8% patch, however, demonstrated noninferior efficacy when compared head-to-head with pregabalin across a wide range of peripheral NP etiologies. Importantly, both treatments demonstrated effective pain relief without the systemic adverse events associated with oral therapies. Conclusion. First-line use of topical agents may be of particular benefit in patients where the safety and tolerability of oral therapy is a concern. J Pain Symptom Manage 2017;53:614e629. Ó
Drug Delivery Letters, 2012
This systematic review and meta-analysis is focusing on the evidences related to iontophoresis used to enhance the topical drug delivery through the skin in the treatment of inflammatory dysfunctions, acute soft tissue injuries and pain. A literature search in the databases, MEDLINE (PubMed), Pedro, and the Cochrane Database of Systematic Reviews was conducted. The methodological quality of the obtained studies was independently rated by two reviewers. Data were pooled from those studies in which the effect of iontophoresis treatment on pain was compared with a control or sham (placebo) intervention. Twenty four experimental studies evaluating the effectiveness of iontophoretic treatment were included. Based on comparable statistical outcome for pain, the results of ten studies could be pooled for metaanalysis. Although several clinical studies claimed an advanced healing process after iontophoresis, controversy on the healing efficacy of iontophoresis remains. The overall summary estimate of the pooled post treatment values for pain was -0.672 [95%CI: -0.970 to -0.375] favouring iontophoresis treatment (p < 0.0001). The observed trend between studies heterogeneity for the post treatment pain values was low to moderate (I 2 = 39.9%; p = 0.092). The results of the metaanalysis indicate quantitative evidence that iontophoresis is effective in the treatment of pain, however, the lack of solid research design in studies on iontophoresis makes it difficult to ensure that the improvements observed can be explained by the iontophoresis technique in se.
Topical patches as treatments for the management of patient musculoskeletal and neuropathic pain
2020
The variety and multiple dimensions of pain (acute/chronic, mild/moderate/severe, nociceptive/neuropathic) requires different pharmacologic and non-pharmacologic treatments in certain patients. A lot of topical formulation, from various therapeutic classes have been proposed in order to decrease systemic exposure and to reduce the risks of adverse events. Topical as well as transdermal drug delivery systems are proposed as medicated plasters with: anesthetics (lidocaine), analgesic or nonsteroidal anti-inflamatory drugs (NSAIDs), alone or co-formulated. Capsaicin, salicylates, menthol and camphor represent the counterirritant class of topical analgesics used as patch active compounds. These compounds produce their analgesic effect by activating and desensitizing epidermal nociceptors. The most used topical treatment in order to decrease pain is the application of cold and heat patches -by acting directly on the affected tissue. In many cases there is a limited number of studies prov...
Topical analgesics for acute and chronic pain in adults - an overview of Cochrane Reviews
The Cochrane library, 2017
Background Topical analgesic drugs are used for a variety of painful conditions. Some are acute, typically strains or sprains, tendinopathy, or muscle aches. Others are chronic, typically osteoarthritis of hand or knee, or neuropathic pain. Objectives To provide an overview of the analgesic e icacy and associated adverse events of topical analgesics (primarily nonsteroidal antiinflammatory drugs (NSAIDs), salicylate rubefacients, capsaicin, and lidocaine) applied to intact skin for the treatment of acute and chronic pain in adults. Methods We identified systematic reviews in acute and chronic pain published to February 2017 in the Cochrane Database of Systematic Reviews (the Cochrane Library). The primary outcome was at least 50% pain relief (participant-reported) at an appropriate duration. We extracted the number needed to treat for one additional beneficial outcome (NNT) for e icacy outcomes for each topical analgesic or formulation, and the number needed to treat for one additional harmful outcome (NNH) for adverse events. We also extracted information on withdrawals due to lack of e icacy or adverse events, systemic and local adverse events, and serious adverse events. We required information from at least 200 participants, in at least two studies. We judged that there was potential for publication bias if the addition of four studies of typical size (400 participants) with zero e ect increased NNT compared with placebo to 10 (minimal clinical utility). We extracted GRADE assessment in the original papers, and made our own GRADE assessment. Main results Thirteen Cochrane Reviews (206 studies with around 30,700 participants) assessed the e icacy and harms from a range of topical analgesics applied to intact skin in a number of acute and chronic painful conditions. Reviews were overseen by several Review Groups, and concentrated on evidence comparing topical analgesic with topical placebo; comparisons of topical and oral analgesics were rare. For at least 50% pain relief, we considered evidence was moderate or high quality for several therapies, based on the underlying quality of studies and susceptibility to publication bias. In acute musculoskeletal pain (strains and sprains) with assessment at about seven days, therapies were diclofenac Emulgel (78% Emulgel, 20% placebo; 2 studies, 314 participants, NNT 1.8 (95% confidence interval 1.5 to 2.1)), ketoprofen gel (72% ketoprofen, 33% placebo, 5 Topical analgesics for acute and chronic pain in adults-an overview of Cochrane Reviews (Review)
Results in Pharma Sciences, 2011
Topical application of NSAIDs is an alternative route to systemic administration when a local antiinflammatory effect of the underlying tissue is a treatment option. The aim of the present microdialysis study was to assess and compare plasma and tissue levels of diclofenac when topically applied with or without iontophoresis in healthy adults. Fourteen healthy adults (26 7 9.4 years) were randomized to diclofenac applied by iontophoresis, or by a gel, in a crossover design. Diclofenac concentrations were measured in plasma and in microdialysis perfusates from the underlying tissues. Iontophoretic application resulted in the highest plasma concentration of 3.4 7 0.5 ng/ml (SEM given) compared to 0.4 ng/ml (at the detection limit) with gel, whereas no differences were observed between tissue concentrations for the two application methods, both being very low, below or around the detection limit. Iontophoresis caused skin reactions in 25% of the participants. Iontophoresis of diclofenac as compared to traditional topical application was not superior in order to increase the NSAID concentration locally and appears to have a higher frequency of skin reactions.