Postgrad Med. 2013 Jul;125(4 Suppl 1):19-24. doi: 10.1080/00325481.2013.1110567011.
The traditional cornerstones of analgesic therapy for patients with acute pain have been oral therapies; however, all oral agents exhibit a variety of potentially dose-limiting or intolerable adverse effects in patients. Elderly patients and those with concomitant conditions already being managed with multiple systemic drugs may be particularly susceptible to systemic toxicities with oral analgesic therapies. Topical agents offer an alternative to oral modalities and can effectively treat patients with acute pain while offering lower systemic absorption and conferring little risk of systemic toxicity. The objective of this article is to review the therapeutic usefulness of available topical therapies in their most thoroughly investigated applications, the treatment of patients with acute musculoskeletal and herpetic pain. For example, although heating pads/wraps and cold packs are widely used to alleviate pain associated with sprains, strains, and contusions, evidence of the effectiveness of these methods is lacking. However, there are sufficient data supporting the use of various topical formulations of nonsteroidal anti-inflammatory drugs (NSAIDs) for these indications (ketoprofen gel or patch, ibuprofen gel or cream, and diclofenac gel or patch), and demonstrating markedly less patient risk of systemic toxicity than is associated with oral NSAID therapy. A ketoprofen patch was shown to be effective and well tolerated in the treatment of patients with tendinopathies. In the treatment of acute neck or low back pain, cold and heat therapies have demonstrated limited effectiveness for patients, and the efficacy of topical NSAIDs has not been established. Use of topical NSAID therapy has been useful in reducing acute-phase herpes zoster pain, and the lidocaine 5% patch has been shown to reduce acute herpetic pain intensity once lesions have healed (the patch cannot be applied to open skin lesions). Topical analgesics represent an alternative treatment modality for patients experiencing acute pain who cannot or choose not to take oral therapies.
镇痛治疗的传统基石一直是口服疗法；然而，所有口服药物在患者中均表现出多种潜在的剂量限制或不可耐受的不良反应。老年患者和那些同时正在接受多种全身药物治疗的患者可能特别容易受到口服镇痛治疗的全身毒性影响。局部制剂为口服方式提供了替代方案，可以有效地治疗急性疼痛患者，同时提供较低的全身吸收，并降低全身毒性的风险。本文的目的是回顾现有局部治疗在其最彻底研究的应用中的治疗效果，即治疗急性肌肉骨骼和疱疹性疼痛患者。例如，尽管加热垫/包裹和冰袋被广泛用于缓解扭伤、拉伤和挫伤引起的疼痛，但缺乏这些方法有效性的证据。然而，有足够的数据支持各种非甾体抗炎药（NSAIDs）局部制剂用于这些适应症（酮洛芬凝胶或贴剂、布洛芬凝胶或乳膏、双氯芬酸凝胶或贴剂），并且与口服 NSAID 治疗相关的全身毒性风险明显降低。酮洛芬贴剂已被证明在治疗肌腱病患者方面有效且耐受良好。在治疗急性颈部或下背部疼痛时，冷热敷疗法对患者的疗效有限，局部 NSAID 的疗效尚未确定。局部使用 NSAID 治疗已被证明可有效减轻急性带状疱疹疼痛，利多卡因 5%贴剂已被证明可减轻疱疹后疼痛的强度（贴剂不能用于开放性皮肤损伤）。对于不能或不愿接受口服治疗的急性疼痛患者，局部镇痛药代表了一种替代治疗方式。
