Rethinking Acute Pain Management in the Age of Prescription Topicals

Do you have patients coping with localized neuropathic pain? Do you wish there were more options in the intervention toolkit for managing this type of pain specifically? As a fellow pharmacist, you might already be aware of a frequently overlooked and underutilized treatment, one that could be considered first by the patient care team: prescription topical pain medications.

Prescription Topicals: An Impactful Middle Ground

My assessment of topical pain medications as underutilized tools may come as a surprise to anyone who has wandered down the pharmacy aisle and seen a surplus of over-the-counter (OTC) treatments, such as warming, cooling, or numbing creams. There are also numerous topical anti-inflammatories from which to choose, including Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) or cannabinoids (CBD). What you can’t find in the pharmacy aisle, however, is this: a high-potency topical approved for prescription use. Why are prescription topicals the way of the future, despite their underuse? Prescription topicals provide an impactful middle ground between OTC targeted topical treatments and oral pain medications.

OTC Topicals and Oral Medications: What are the challenges?

While highly effective for many types of pain management, OTC topicals can’t meet the needs of all patients. Even though many patients may benefit from these medications in the short term, others may need more relief.

For these patients, non-opioid prescription oral medications are often used as first-line treatments. In recent years, concerns about opioid use, misuse, and abuse have propelled healthcare professionals and patients alike to seek other options for pain management, highlighting the importance of evaluating the effectiveness of all available pain management options.

Finding a Middle Ground with Prescription Topicals

Health care professionals in the know often prescribe topical medications because they deliver targeted relief with reduced systemic exposure.¹ These patches and creams can be effective options for patients seeking minor acute pain relief. Prescription topicals are available in higher-potency formulations, have been extensively studied, and carry FDA approval for a wide range of painful conditions.

Who Stands to Benefit? Our Patients

Topical patches can be important options for patients who may not tolerate certain oral pain treatments, are unable to take drugs orally or who want to avoid taking an additional oral medication while already managing multiple prescriptions. These medications might be particularly helpful as well to patients who tell you they have “tried everything” - or for those who are wary of oral pain medications. Topical patches are contraindicated in certain patients, so it is important to understand the individual patient’s medical history and if the specific topical patch is right for them.

How to Maximize Patient Outcomes with Prescription Topicals

So how should you dispense these medications?

In my view, prescription topical pain medications continue to demonstrate their value in modern pain management. By delivering relief right where it’s needed, they help reduce unwanted systemic effects and offer an appealing option for many patients. As awareness grows among both healthcare providers and patients, these therapies are poised to play an even greater role — so, let’s all start considering prescription topicals as an option for first-line intervention in acute pain management.

References

1. Barkin RL. The pharmacology of topical analgesics. Postgrad Med. 2013 Jul;125(4 Suppl 1):7-18. doi: 10.1080/00325481.2013.1110566911. PMID: 24547599.

About the Author: Mark Garofoli, PharmD, MBA, BCGP, CPE, CTTS, clinical assistant professor and director of experiential learning at West Virginia University School of Pharmacy. Mark serves as a paid advisor to YARAL Pharma.