Analgésicos tópicos

Murilo Pereira Flores; Anita Perpetua Carvalho Rocha de Castro; Jedson dos Santos Nascimento

doi:10.1590/S0034-70942012000200010

Review Article

Analgésicos tópicos

Topical analgesics

Murilo Pereira Flores; Anita Perpetua Carvalho Rocha de Castro; Jedson dos Santos Nascimento

http://dx.doi.org/10.1590/S0034-70942012000200010 Braz J Anesthesiol, vol.62, n2, p.248-252, 2012

PDF

Downloads: 0

Resumo

JUSTIFICATIVA E OBJETIVOS: O tratamento da dor envolve a utilização de analgésicos opioides, analgésicos comuns, anti-inflamatórios não hormonais (AINH's) e analgésicos adjuvantes. Tradicionalmente, estes fármacos são administrados por via sistêmica ou no neuroeixo. Entretanto, quando aplicados por estas vias, estão associados a efeitos colaterais importantes, os quais podem inviabilizar o seu uso. A administração tópica de analgésicos é uma alternativa. O objetivo deste trabalho é discutir os analgésicos tópicos, seus mecanismos de ação e eficácia clínica. CONTEÚDO: Trata-se de um trabalho de revisão que aborda a utilização tópica de anestésicos locais, capsaicina, clonidina, antidepressivos tricíclicos, cetamina, opioides e canabinoides, discutindo o seu mecanismo de ação e a sua eficácia. CONCLUSÕES: Os analgésicos tópicos são promissores como estratégia para o tratamento da dor, já que estão associados à menor incidência de efeitos colaterais. O benefício dos anestésicos locais, dos AINH's e da capsaicina está bem estabelecido, entretanto, a eficácia de clonidina, antidepressivos tricíclicos, cetamina, opioides e canabinoides ainda é questionável. Trabalhos demonstram que a abordagem multimodal é uma alternativa, porém estudos são necessários para confirmar esta hipótese.

Palavras-chave

ANALGESIA, ANALGÉSICOS, ANALGÉSICOS, ANALGÉSICOS, Canabinoides, ANESTESIA, Antidepressivos, Capsaicina, DOR

Abstract

BACKGROUND AND OBJECTIVES: Pain treatment involves the usage of common and opioid analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs) and adjuvant analgesics. Traditionally, these drugs are administered systemically or into the neuraxis. However, when analgesics are applied through these pathways, they are associated with significant side effects, which can hinder its use. Topical administration of analgesics is an alternative. The objective of this paper is to discuss topical analgesics, the mechanisms of action and clinical efficacy. CONTENT: This is a review paper addressing the usage of the topical local anesthetics: capsaicin, clonidine, tricyclic antidepressants, ketamine, opioids and cannabinoids, discussing mechanism of action and effectiveness. CONCLUSIONS: Topical analgesics are promising as a strategy for pain treatment, as they are associated with lower incidence of side effects. The benefit of local anesthetics, NSAID's and capsaicin is well established. However, the efficacy of clonidine, tricyclic antidepressants, ketamine, opioids and cannabinoids is still questionable. Studies have shown that the multimodal approach is an alternative, but studies are needed to confirm this hypothesis.

Keywords

Administration, Analgesia, Analgesics, Anesthetics, Antidepressive Agents, Anti-inflammatory Agents, Cannabinoids, Capsaicin, Ketamine

Referências

McCleane G. Topical analgesics. Anesthesiol Clin. 2007;25:825-839.

Haroutiunian S, Drennan DA, Lipman AG. Topical NSAID therapy for musculoeskeletal pain. Pain Medi. 2010;11:535-549.

de Leon-Casasola OA. Multimodal approaches to the management of neuropathic pain: the role of topical analgesia. J Pain Symptom Manage. 2007;33(3):356-364.

Heyneman CA, Lawless-Liday C, Wall GC. Oral versus topical NSAI-Ds in rheumatic diseases: a comparison. Drugs. 2000;60:555-574.

Roelofs PD, Deyo RA, Koes BW, Scholten RJ, van Tulder MW. Nonsteroidal anti-inflammatory drugs for low back pain: an updated Cochrane review. Spine. 2008;33(16):1766-1774.

Finnerup NB, Otto M, McQuay HJ, Jensen TS, Sindrup SH. Algorithm for neuropathic pain treatment: an evidence based proposal. Pain. 2005;118(3):289-305.

Lai J, Porreca F, Hunter JC, Gold MS. Voltage-gated sodium channel and hyperalgesia. Annu Rev Pharmacol Toxicol. 2004;44:371-397.

Gammaitoni AR, Alvarez NA, Galer BS. Pharmacokinetics and safety of continuously applied lidocaine patches 5%. Am J Health Syst Pharm. 2000;59(22):2215-2220.

Katz NP, Gammaitoni AR, Davis MW, Dworkin RH. Lidocaine patch 5% reduces pain intensity and interference with quality of life in pacients with postherpetic neuralgia: an effectiveness trial. Pain Med. 2002;3(4):324-332.

Barbano RL, Herrmann DN, Hart-Gouleau S, Pennella-Vaughan J, Lodewick PA, Dworkin RH. Effectiveness, tolerability, and impact in quality of life of he %5 lidocaine patch in diabetic polineuropathy. Arch Neurol. 2004;61(6):914-91.

Meier T, Wasner G, Faust M. Efficacy of lidocaine patch 5% in the treatment of focal peripheral neuropathic pain syndromes: a randomized, double-blind, placebo-controlled study. Pain. 2003;106:151-158.

Attal N, Brasseur L, Chauvin M, Bouhassira D. Effects of single and repeated applications of a eutectic mixture of local anaesthetics (EMLA) cream on spontaneous and evoked pain in post-herpetic neuralgia. Pain. 1999;81:203-209.

Mason L. Systematic review of topical capsaicin for the treatment of chronic Pain. British Journal of Medicine. 2004;7446:328-991.

Nolano M, Simone DA, Wendelschafer-Crabb G, Johnson rT, Hazen E, Kennedy WR. Topical capsaicin in humans: parallel loss of epidermal nerve fibres and pain sensation. Pain. 1999;81:135-145.

Simone DA, Nolano M, Johnson T, Wendelschafer-Crabb G, Kennedy WR. Intradermal injection of capsaicin in humans produces degeneration and subsequent reinnervation of epidermal nerve fibres: correlation with sensory function. J Neurosci. 1998;18:8947-8959.

Dogrul A. Topical clonidine antinociception. Pain. 2004;111:385-391.

Byas-Smith MG. Transdermal clonidine compared to placebo in painful diabetic neuropathy using a two-stage 'enriched enrollment' design. Pain. 1995;60(3):267-274.

Ho K, Huh BK, White WD, Yeh CC, Miller EJ. Topical Amitriptyline Versus Lidocaine in the Treatment of Neuropathic Pain. Clin J Pain. 2008;24:51-55.

Lockhart E. Topical combination of amitriptyline and ketamine for post herpetic neuralgia. J Pain. 2004;5(^s1):82.

McCleane G. Topical application of doxepin hydrochloride, capsaicin and a combination of both produces analgesia in chronic human neuropathic pain: a randomized, double-blind, placebo-controlled study. Br J Clin Pharmacol. 2000;49:574-579.

Epstein JB, Epstein JD, Epstein MS, Oien H, Truelove EL. Oral topical doxepin rinse: analgesic effect in patients with oral mucosal pain due to cancer or cancer therapy. Oral Oncol. 2001;37:632-637.

Gammaitoni A. Topical ketamine gel: possible role in treating neuropathic pain. Pain Med. 2000;1(1):97-100.

Crowley KL, Flores JA, Hughes CN, Iacono RP. Clinical application of ketamine ointment in the treatment of significant allodynia and hyperalgesia associated with chronic neuropathic pain. J Pharm Comp. 1998;2:123-127.

Finch PM. Reduction of allodynia in patients with complex regional pain syndrome: A double-blind placebo-controlled trial of topical ketamine. Pain. 2009;146:18-25.

Flock P, Gibbs L, Sykes N. Diamorphine metronidazole gel effective for treatment of painful infected leg ulcers. J Pain Symptom Manage. 2000;20:396-397.

Zeppetella G, Paul J, Ribeiro MDC. Analgesic efficacy of morphine applied topically to painful ulcers. J Pain Symptom Manage. 2003;25:555-558.

Zeppetella G, Ribeiro MD. Morphine in intra-site gel applied topically to painful ulcers. 2005;29:118-119.

Cerchietti LCA, Navigante ArH, Bonomi MR. Effect of topical morphine for mucositis-associated pain following concomitant chemoradiotherapy for head and neck carcinoma. Cancer. 2002;95:2230-2236.

Dogrul A. Topical cannabinoid antinociception. Pain. 2003;105:11-16.

Yesilyurt O. Topical cannabiboid enhances topical morphine antinociception. Pain. 2003;105:303-308.

Analgésicos tópicos

Topical analgesics

Murilo Pereira Flores; Anita Perpetua Carvalho Rocha de Castro; Jedson dos Santos Nascimento

Resumo

Palavras-chave

Abstract

Keywords

Referências

Links

Compartilhar

Braz J Anesthesiol