Balancing Topical and Systemic Pain Medications

Managing chronic pain is a complex task due to the varying effectiveness of treatments and the unique pain experiences of individuals. In the U.S., about 20.4% of adults experience chronic pain, and 8% face high-impact chronic pain that limits daily activities. Traditional oral medications like acetaminophen, NSAIDs, and opioids are commonly used but carry significant systemic risks. To mitigate these risks, alternative drug delivery methods, such as topical medications, have been developed.

Topical medications are applied directly to the skin over the painful area, potentially reducing systemic side effects. However, their effectiveness depends on the ability of the active ingredient to penetrate the skin barrier. Various formulations, including creams, gels, and ointments, offer different levels of penetration and cosmetic acceptability. Common active ingredients in topical products include local anesthetics (e.g., lidocaine), NSAIDs (e.g., diclofenac), and counterirritants (e.g., capsaicin).

Topical analgesics offer several advantages, such as a lower risk of systemic side effects and ease of use for patients who have difficulty swallowing pills. However, they also have drawbacks, including potential for skin irritation and variable absorption rates. Pain treatment guidelines, such as those from the Official Disability Guidelines (ODG), recommend topical analgesics based on specific conditions and evidence of effectiveness. Cost considerations for compounded or private-label products remain a challenge, requiring regular review and prior authorization for use in PBM programs.