What is the role of topical therapy in the treatment of low back pain (LBP)?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Answer

Topical treatment is drug delivery over or onto the painful site. The medication is delivered through the skin to a shallow depth (< 2 cm) and acts locally, without producing significant systemic serum levels or side effects. A commonly prescribed topical treatment for nociceptive and neuropathic pain is the 5% lidocaine patch. The patch is FDA-approved for the treatment of postherpetic neuralgia and has been demonstrated as an effective treatment for chronic LBP. [116]

Almost any imaginable drug combination can be compounded by a competent local pharmacist to create an effective topical application. NSAIDs can be mixed with local anesthetics, AEDs, TCAs, and norepinephrine/epinephrine (sympathetic nervous system) antagonists to calm down pain and autonomic dysfunction associated with chronic spinal-radicular syndromes. Sometimes, compounding topical creams/lotions gives the treating physician the greatest latitude to treat symptoms, especially allodynia, without worrying about the medications' systemic side effects.


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