Topical Analgesic and Local Anesthetic Agents for Pain Associated with Chronic Leg Ulcers: A Systematic Review

Abstract

GENERAL PURPOSE To provide information about the effectiveness of topical analgesic and local anesthetic agents for reducing pain associated with chronic leg ulcers. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will: 1. Distinguish adverse reactions to topical analgesics and local anesthetic agents. 2. Evaluate the effectiveness of topical analgesics and local anesthetic agents for pain associated with chronic leg ulcers. 3. Identify substances used as topical analgesics and local anesthetic agents and the application of those agents. OBJECTIVE To examine the evidence related to the effectiveness of topical analgesic and topical local anesthetic agents for reducing pain associated with chronic leg ulcers. METHODS A systematic search and review of the literature were undertaken using key search terms such as leg ulcers, topical anesthetics, topical analgesics, and pain. Six databases were electronically searched for articles published between January 1990 and August 2019. RESULTS A total of 23 articles were identified that met the inclusion criteria. Data were extracted using content analysis. Most of the included studies were randomized controlled trials; however, the reported methodology for most of studies was poor, so the validity and reliability of the evidence are uncertain. Lidocaine/prilocaine cream, ibuprofen foam, and morphine gel were the most examined topical agents. Lidocaine/prilocaine cream significantly improved wound-related pain compared with all other studied agents. For topical analgesic agents, ibuprofen foam reduced chronic leg ulcer pain significantly, whereas morphine gel was ineffective. CONCLUSIONS Lidocaine/prilocaine cream and ibuprofen foam are effective agents for reducing wound-related pain associated with chronic leg ulcers. Effective use of topical agents could reduce the need for systemic pain relief agents, mitigating potential adverse effects, while giving clinicians another treatment option to manage wound-related pain associated with chronic leg ulcers.

Systematic review of topical interventions for the management of pain in chronic wounds

“…34,35 There exists several topical-based preparations for the prevention, management, and treatment of chronic pain and wound-associated pain, including local anaesthetics, anti-inflammatory foam dressings, and topical opioid medication. 1,5,25,30 The therapeutic potential of topical cannabis-based medicines for the management of wound-associated pain and wound healing has been highlighted in several recent case reports. 7,21,22 A previous Cochrane review of topical agents or dressings for pain limited to those with venous leg ulcers only identified 2 randomised controlled trials (RCTs) meeting their criteria.…”

Pain Management of the Patient With Monkeypox Virus

“…Other recent studies have supported these beneficial findings of the efficacy of lidocaine. 16 In contrast, EMLA cream (a mixture of lidocaine and prilocaine) is contraindicated in open wounds due to the risk of methemoglobin.…”

“…Despite none having FDAapproved neuropathic pain management indications, this class of agents is among those preferred as first-line treatment by the International Association for the Study of Pain (IASP) evidence-based guidelines for pharmacological management of neuropathic pain. 16 TCAs have quite an extensive history, and their role in the treatment of neuropathic pain has been highlighted by an assortment of randomized controlled trials.…”

A practical, comprehensive guide to pain management hidradenitis suppurativa

“…Once opioid-sparing options have been exhausted, opioids may also be considered for pain management in HS. 71 To manage pain during infrequent, severe HS flares, strategies such as providing short courses of opioids may help prevent unplanned emergency department visits. For management of acute pain, the CDC Guideline recommends using the lowest effective dose of immediate-release opioids for ≤3 days.…”