E XTERNAL A NALGESICS By: Vaughn Benton

L EARNING O BJECTIVES U PON COMPLETION OF THIS PRESENTATION, THE STUDENT WILL BE ABLE TO : 1. Define the term “external analgesic” 2. List the various topical drugs available as nonprescription external analgesic products (generic and brand names) 3. Discuss the differences in mechanisms of action between the various external analgesic products identified 4. Identify specific factors to discuss when providing patient education

S O... W HAT ARE E XTERNAL A NALGESICS ?  An external analgesic is a medication for pain management designed to be applied externally, rather than being taken internally.  For the treatment and management of musculoskeletal injuries and disorders, many patients commonly use nonprescription topical analgesics.  Available in several different formulations, including gels, ointments, creams, lotions, sprays, and patches,  These products may have local analgesic, anesthetic, antipruritic and/or counterirritant effects.

W HY S O S ERIOUS ?

I DENTIFICATION 1. Methyl Salicylate 2. Trolamine Salicylate 3. Menthol 4. Camphor 5. Capsaicin

M ETHYL S ALICYLATE Origin Oil of Wintergreen Effect When Applied Rubefacient produces redness of the skin e.g. by causing dilation of the capillaries and an increase in blood circulation.

T ROLAMINE S ALICYLATE Origin Salt formed between triethanolamine and salicylic acid Effect When Applied Rubefacient Produces redness of the skin e.g. by causing dilation of the capillaries and an increase in blood circulation.

M ENTHOL Origin Peppermint and Other Mint Oils Effect When Applied Cooling

C AMPHOR Origin Wood of camphor laurel, a large evergreen in Asia Effect When Applied

C APSAICIN Origin Chili Peppers Effect When Applied Burning

P RODUCTS Y OU ’ RE F AMILIAR W ITH...

Flex-power was founded in 2001 for athletes who disliked the smell of existing sports-related pain relief products. They received guidance from PowerBar founder, Brian Maxwell and hired scientists who developed the Flexpower formula within a year. The company indicates that liposome nanotechnology is used in Flex-power to embed the active ingredients in tiny particles for delivery through the skin.

T IGER K NOWS B EST

C LINICAL T EACHING 1. Pharmacists should advise patients that nonprescription topical analgesics are intended to treat mild to moderate pain for no longer than 7 days. 2. Factors that may be considered when selecting a nonprescription topical analgesic include dosage form, cost, ease of use, odor, and the patient’s medical history, including possible allergies. 3. Patients who are taking anticoagulation therapy should be cautioned not to use topical products that contain salicylates

C LINICAL T EACHING 4. Patients should be counseled on the proper use of these products, which include using them as directed and only applying topical products to intact skin. 5. Hands should always be washed after applying topical products and before touching the eyes or mucous membranes. 6. Patients should be advised to consult their primary health care provider if pain changes in severity or persists after 7 days of self-treatment.

M ISCONCEPTIONS & P RECAUTIONS 1. “Its perfectly alright to take a spoonful of Vick’s VapoRub by mouth.” 2. Pad and Patch Don’t Match! 3. Location, location, location

V AUGHN B ENTON F OR M R. COPPS