Postgrad Med. 2013 Jul;125(4 Suppl 1):34-41. doi: 10.1080/00325481.2013.1110567211.
Topically applied analgesic therapies have been used throughout history to treat a variety of patient conditions that present with pain. Before modem pharmaceuticals became readily available, mud-based emollients, salves, cold therapies, and other natural remedies were often used. Now we have effective therapies and are developing advanced topical analgesics as we learn more about the physiology and pathophysiology of pain. The use of topical analgesics may be associated with fewer patient systemic side effects than are seen with oral, parenteral, or transdermally administered agents, making the topical route of administration attractive to prescribers and patients. With further refinement of existing drugs and the development of novel agents, topical analgesics may offer relief for treating patient pain conditions that are currently challenging to treat, such as pain resulting from burns, wound debridement, and pressure ulcers. Recognizing the value of a multimodal approach, topical analgesics may offer a therapeutic option that can become part of a comprehensive treatment plan for the patient. With continued advancements in targeted drug-delivery systems, topical analgesics may be able to provide a method to prevent or reverse the phenomena of peripheral and central sensitization, or the neuroplastic changes believed to be responsible for the transition from acute to chronic pain states in patients. For those patients at risk for developing chronic pain states, such as complex regional pain syndrome, the combination of cutaneous stimulation (achieved through rubbing during application) and analgesic effects produced by the drug itself may prevent the disabling pain that often emerges during the subacute phase of disease. In summary, better utilization of currently available topical analgesics and continued research promise to ensure that topical analgesics are, and will continue to be, important tools in the treatment of patients with resistant pain.
局部应用的镇痛疗法在历史上一直被用于治疗各种伴有疼痛的患者疾病。在现代药物广泛应用之前，泥基润肤剂、软膏、冷疗和其他天然疗法经常被使用。现在，随着我们对疼痛的生理学和病理生理学有了更多的了解，我们已经有了有效的治疗方法，并正在开发先进的局部镇痛药物。与口服、肠胃外或经皮给予的药物相比，局部应用镇痛药物可能与较少的患者全身副作用相关，这使得局部给药途径对处方者和患者都具有吸引力。随着现有药物的进一步改进和新型药物的开发，局部镇痛药物可能为治疗目前具有挑战性的患者疼痛状况提供缓解，例如烧伤、清创和压疮引起的疼痛。认识到多模式方法的价值，局部镇痛药物可能提供一种治疗选择，可以成为患者综合治疗计划的一部分。随着靶向药物输送系统的不断进步，局部镇痛药物可能能够提供一种方法来预防或逆转周围和中枢敏化的现象，或被认为是导致患者从急性疼痛状态向慢性疼痛状态转变的神经可塑性变化。对于那些有发展为慢性疼痛状态风险的患者，如复杂性区域疼痛综合征，皮肤刺激（通过涂抹时的摩擦实现）和药物本身产生的镇痛作用的组合可能预防在疾病亚急性期经常出现的致残性疼痛。总之，更好地利用现有的局部镇痛药物和持续的研究有望确保局部镇痛药物是且将继续成为治疗耐药性疼痛患者的重要工具。
