Topical medications

Topical capsaicin 0.075 percent reduces pain in PHN.67[II] Capsaicin is an agonist of the vanilloid receptor which is present on the terminals of primary nociceptive afferents. On initial application it has an excitatory action and produces burning pain and hyperalgesia, often leading to discontinuation of its use. However, with perseverance and repeated and prolonged application, it inactivates the receptive terminals of nociceptors. Recent work investigating the use of high-concentration topical capsaicin (8 percent) following topical local anesthetic pretreatment gives some cause for hope that this therapy may prove useful.68 [V] Therefore, this approach is reasonable for those patients whose pain is maintained by anatomically intact sensitized nociceptors and in whom long-term side effects do not exceed benefit. Topical lidocaine patches (5 percent) placed over the painful area for approximately 12 hours each day may provide significant pain relief in PHN.69,70[II] Blood levels of lidocaine are very low and do not explain the analgesic effect. Minor side effects, such as local irritation or rash, occur in some patients. Lidocaine patch therapy is a safe and well-tolerated supplemental modality for PHN pain relief. Because of fewer side effects it is generally preferred over topical capsaicin.

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