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Safaeian P, Mattie R, Hahn M, et al. Novel Treatment of Radicular Pain With a Multi-Mechanistic Combination Topical Agent: A Case Series and Literature Review. Anesth Pain Med. 2016;6(2):e33322doi: 10.5812/aapm.33322.
Safaeian, P., Mattie, R., Hahn, M., Plastaras, C. T., & McCormick, Z. L. (2016). Novel Treatment of Radicular Pain With a Multi-Mechanistic Combination Topical Agent: A Case Series and Literature Review. Anesthesiology and pain medicine, 6(2), e33322. https://doi.org/10.5812/aapm.33322
Safaeian, Pegah, et al. "Novel Treatment of Radicular Pain With a Multi-Mechanistic Combination Topical Agent: A Case Series and Literature Review." Anesthesiology and pain medicine vol. 6,2 (2016): e33322. doi: https://doi.org/10.5812/aapm.33322
Safaeian P, Mattie R, Hahn M, Plastaras CT, McCormick ZL. Novel Treatment of Radicular Pain With a Multi-Mechanistic Combination Topical Agent: A Case Series and Literature Review. Anesth Pain Med. 2016 Mar 01;6(2):e33322. doi: 10.5812/aapm.33322. eCollection 2016 Apr. PMID: 27252902; PMCID: PMC4886452.
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Anesth Pain Med. 2016 Mar 01;6(2):e33322. doi: 10.5812/aapm.33322. eCollection 2016 Apr.

Novel Treatment of Radicular Pain With a Multi-Mechanistic Combination Topical Agent: A Case Series and Literature Review.

Anesthesiology and pain medicine

Pegah Safaeian, Ryan Mattie, Matthew Hahn, Christopher T Plastaras, Zachary L McCormick

Affiliations

  1. Department of Physical Medicine and Rehabilitation, The Rehabilitation Institute of Chicago, Northwestern Feinberg School of Medicine, Chicago, USA.
  2. Department of Orthopaedics, Stanford University, Palo Alto, USA.
  3. Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
  4. Department of Physical Medicine and Rehabilitation, The Rehabilitation Institute of Chicago, Northwestern Feinberg School of Medicine, Chicago, USA; Department of Anesthesiology, Northwestern Feinberg School of Medicine, Chicago, USA.

PMID: 27252902 PMCID: PMC4886452 DOI: 10.5812/aapm.33322

Abstract

INTRODUCTION: Pharmacologic treatment of radicular pain with oral medications is limited by adverse effects and concern for dependence. While topical formulations have been explored in pain research, there is no published literature evaluating the efficacy in radicular pain. We present the first three cases of radicular pain successfully treated with a topical formulation of diclofenac, ibuprofen, baclofen, cyclobenzaprine, bupivacaine, gabapentin, and pentoxifylline (T7).

CASE PRESENTATION: Case series evaluating T7 for treatment of radicular pain in a single, outpatient pain center. Pain was rated on the numeric rating scale (NRS) on initial evaluation and follow up after a trial of T7. One to two grams of T7 was applied to the affected area 3 - 4 times daily in addition to the patient's baseline pharmacologic management. Three patients with median age of 50 (range, 39 to 65) and diagnosis of cervical and/or lumbosacral radicular pain participated. Two of the three had chronic radicular pain despite use of analgesic agents, spinal injections and failed spinal surgery syndrome. Each reported subjective improvement in radicular pain, function and sleep. There was an average decrease in NRS score consistent with 30% - 40% global improvement in symptoms, clinically significant based on the minimal clinically important difference for radicular pain. T7 was well tolerated without adverse reactions. Surgery was prevented or delayed in all cases.

CONCLUSIONS: This is the first report of the successful treatment of radicular pain with a topical agent. This highlights the need for randomized, prospective study of both single and compounded topical agents for treatment of radicular pain.

Keywords: Administration; Anesthetics; Neuralgia; Radiculopathy; Topical

References

  1. Acta Otorhinolaryngol Ital. 2004 Oct;24(5):279-83 - PubMed
  2. J Pain. 2011 Feb;12(2):157-66 - PubMed
  3. Med Sci Sports Exerc. 1997 Jul;29(7 Suppl):S236-45 - PubMed
  4. Clin J Pain. 2014 Jan;30(1):73-91 - PubMed
  5. J Pain Symptom Manage. 2013 Oct;46(4):e4-5 - PubMed
  6. Ann Neurol. 1984 Mar;15(3):240-4 - PubMed
  7. Clin J Pain. 2007 Feb;23(2):143-9 - PubMed
  8. Clin J Pain. 2000 Sep;16(3):205-8 - PubMed
  9. Neurology. 2007 Apr 10;68(15):1178-82 - PubMed
  10. Pain Manag. 2012 May;2(3):239-50 - PubMed
  11. Pain. 2009 Dec 15;147(1-3):5-6 - PubMed
  12. Arch Phys Med Rehabil. 1994 Mar;75(3):342-52 - PubMed
  13. Curr Pain Headache Rep. 2012 Jun;16(3):191-8 - PubMed
  14. Am J Ther. 2015 May-Jun;22(3):214-21 - PubMed
  15. BMJ Clin Evid. 2014 Oct 06;2014:null - PubMed
  16. Eur Spine J. 2007 Jul;16(7):881-99 - PubMed
  17. Support Care Cancer. 2011 Jun;19(6):833-41 - PubMed
  18. World J Diabetes. 2015 Apr 15;6(3):432-44 - PubMed
  19. Dent Clin North Am. 2013 Jul;57(3):541-53 - PubMed
  20. Mayo Clin Proc. 2015 Apr;90(4):532-45 - PubMed
  21. J Manipulative Physiol Ther. 2013 Jan;36(1):2-11 - PubMed
  22. Eur Neurol. 1985;24(6):380-5 - PubMed
  23. Clin J Pain. 1992 Dec;8(4):338-45 - PubMed
  24. Pain Med. 2005 Sep-Oct;6(5):379-84 - PubMed
  25. Clin J Pain. 2003 Sep-Oct;19(5):323-8 - PubMed
  26. Br J Clin Pharmacol. 2000 Jun;49(6):574-9 - PubMed
  27. Br J Radiol. 2004 Oct;77(922):885-7 - PubMed
  28. BMC Anesthesiol. 2015 Sep 22;15:126 - PubMed
  29. Anesth Prog. 2006 Fall;53(3):98-108; quiz 109-10 - PubMed
  30. Phys Med Rehabil Clin N Am. 2011 Feb;22(1):127-37 - PubMed
  31. Mayo Clin Proc. 2013 Feb;88(2):195-205 - PubMed
  32. BMJ. 2015 Apr 16;350:h1748 - PubMed
  33. Eur Spine J. 2002 Feb;11(1):57-61 - PubMed
  34. Arch Neurol. 2004 Jun;61(6):914-8 - PubMed
  35. Ann Neurol. 1987 May;21(5):514-5 - PubMed
  36. Arch Neurol. 2003 Nov;60(11):1524-34 - PubMed
  37. Int J Pharm Compd. 2014 Nov-Dec;18(6):504-11 - PubMed
  38. J Back Musculoskelet Rehabil. 2009;22(1):17-20 - PubMed
  39. J Pain Res. 2010 Dec 20;4:11-24 - PubMed
  40. Pain. 2003 Nov;106(1-2):151-8 - PubMed
  41. Cochrane Database Syst Rev. 2014 Apr 27;(4):CD007938 - PubMed
  42. Pain Med. 2003 Dec;4(4):321-30 - PubMed
  43. Arch Gynecol Obstet. 2014 Aug;290(2):389-93 - PubMed
  44. Anesthesiology. 2000 Mar;92(3):876-80 - PubMed
  45. Br J Dermatol. 2015 Jul;173(1):300-2 - PubMed
  46. Eur J Pain. 2009 May;13(5):439-40 - PubMed
  47. Lancet Neurol. 2015 Feb;14(2):162-73 - PubMed
  48. J Toxicol Sci. 1991 Feb;16 Suppl 1:3-20 - PubMed
  49. Nature. 2007 Feb 22;445(7130):858-65 - PubMed
  50. Eur Neurol. 1984;23(1):51-5 - PubMed
  51. Obstet Gynecol. 2008 Sep;112(3):579-85 - PubMed
  52. Can J Physiol Pharmacol. 1981 Jan;59(1):37-44 - PubMed
  53. Pain. 1988 Jun;33(3):333-40 - PubMed
  54. Neurol Med Chir (Tokyo). 2010;50(12):1070-3 - PubMed
  55. Indian J Dent Res. 1989 Oct-Dec;1(4):109-13 - PubMed
  56. Drugs. 1987 Jul;34(1):50-97 - PubMed
  57. BMJ. 2004 Apr 24;328(7446):995 - PubMed
  58. Eur J Dermatol. 2008 Mar-Apr;18(2):119-27 - PubMed
  59. Spine (Phila Pa 1976). 2008 Sep 1;33(19):2041-6 - PubMed
  60. Exp Neurol. 2014 Feb;252:95-103 - PubMed
  61. Pain Res Manag. 2009 Sep-Oct;14(5):381-8 - PubMed
  62. J Neurol Sci. 2008 Dec 15;275(1-2):164-6 - PubMed
  63. Ann Rheum Dis. 2004 Sep;63(9):1180-1 - PubMed
  64. Int J Gen Med. 2014 Dec 19;8:9-14 - PubMed
  65. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Oct;114(4):449-56 - PubMed
  66. Clin J Pain. 2002 Sep-Oct;18(5):297-301 - PubMed
  67. Cochrane Database Syst Rev. 2013 Feb 28;(2):CD007393 - PubMed
  68. Curr Med Res Opin. 2011 Oct;27(10):2069-71 - PubMed

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