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Flashcards in 12 - External Analgesics Deck (29)
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1

BENGAY

Ingredients & Indication & Dose

MENTHOL
some might have camphor / methyl salicylate

AAA 3-4 times a day
do NOT use with heating pads / devises

 

Minor Aches
Pains of muscles & joints associated w/
 arthritis / backaches / strains / sprains / bruises

2

BENGAY

ADR / CI / PC

Do not apply to open / broken skin
avoid contact w/ eyes / mucous membranes
no bandages / heating pads

 

7 DAYS AT MOST

rare allergic reactions

 

3

Capzasin-P & -HP

Ingredients / Indication / Dose

CAPSAICIN
0.35% / 0.1%
some combos might have menthol

AAA 3-4 times a day

Temporary relief of pain from:
RA / OA
 Neuralgias
 (Shingles / DM neuropathy)

4

Capzasin-P & -HP

ADR / CI / CP

AVOID contact with eyes / broken skin 
do NOT use occlusion

Contact MD if no improvement in
 28 days or gets worse

effects may take
up to 2 weeks to be noticed

Transient burning/stinging will occur
dissapears after several days of use

 

5

Okay to self treat vs EX-ST

Myalgias

External Analgesics

Myalgia / General Muscle pain from overuse
Delayed onset = ~8 hours
Peaks @ 24-48 hours after overexertion
Bursitis / Tendonitis / Repetitive strain injury

 

EXCLUDED FOR MYALGIAS CAUSED BY:
Systemic Infections
Chronic
 disorders
Medications (statins)

6

Okay to self treat vs EX-ST

SOFT-Tissue Injury

External Analgesics

Okay to Treat for Soft Tissue injury to:
LIGAMENTS / MUSCLE / TENDONS
GRADE 1 = Excessive stretching

 

AVOID IF INJURY WITH:
Abnormal joint movement
visible joint deformity

7

Okay to self treat vs EX-ST

Osteoarthritis / Chronic Neuronogic Pain

External Analgesics

Okay to treat ONLY AFTER HCP DIAGNOSIS
Osteoarthritis
Diabetic Neuropathy / Post-Herpetic Neuralgia

 

only treat AFTER DIAGNOSIS

8

Conditions Approved to SELF TREAT
with external analgesics

Acute Lower Back Pain
except if >6 weeks

Myalgia / Overuse Injuries
not from chronic / medication / systemic infections

Grade 1 Soft Tissue Injuries
no visible/abnormal joints

Osteoarthritis / Chronic Neurologic Pain
only AFTER being DIAGNOSED by HCP

9

Symptoms that EXCLUDE SELF CARE

for external analgesics

Food-Intake related
ulcer / gastritis

Pain -> radiates to LEFT arm or UP jaw "CRUSHING"
ANGINA / MI

Erythema / Wamth around joint
infections / inflammatory arthritis

Systemic Symptoms
SOB / Fever / NVD

Swelling / tenderness / WARMTH
DVT

Pelvic or AB-pain (other than dysmenorrhea)
Appendicitis / Pelvic Inflammatory disease / Pyelonephritis

 

10

General EX-ST

External Analgesics

<2 y/o & pregnancy
OTC toxicity / systemic absorption

Severe pain 
 >6 pain score on 1-10 scale

Pain presistance
 >10 days except for acute lower back pain <6 weeks okay
>7 days AFTER treatment/self care
worsening of severity or nature of pain

Back pain w/ loss of bladder/bowel fxn

11

PQRST

Assessment Questions for External Analgesics

Precipitating Factor
is pain related to specific activity?

Quality
describe the pain + other symptoms

Region
localization / JOINT?

Severity

Time

12

When to REFER for 
P

in PQRST

Precipitating Factor
Is the pain related to a specific activity?

 

Refer if:
pain occured 
after a prolonged period of IMMOBILIZATION
plane&car ride / bedridden / hospitilization

13

When to REFER for 
Q

in PQRST

Quality
Can you describe the pain?
Are there any other symptoms?

 

Refer if:
Pain is neurologic in nature or if systemic symptoms
burn/ tingle/ electrical/ numb) / (limb weakness / swelling/redness)
 

14

When to REFER for 
R

in PQRST

REGION
Where is the pain / Localized?
is the pain in or around a JOINT?

Refer if:
Pain follows a nerve path = Shooting pain
if pain in non-localizable = generalized pain
if there is joint redness / tenderness / swelling
if there is prolonged/pronounced STIFFNESS after period of inactivity
if there is joint deformity / abnormal movement

15

When to REFER for 
S

in PQRST

Severity
how severe is the pain?

 

Refer if:
If pain is constant and doesnt abate with rest​ of AA
if pain is moderate - severe = >6 on 1-10 scale

16

When to REFER for 
T

in PQRST

TIME
How long has the pain been present
How Often does the pain occur

REFER if:
pain is present for >10 days
if lower back pain >6 weeks
>7 days after treatment / self care
if pain intensity increases / resolves->reoccurs

17

RICE

Non-Drug Therapy for External Analgesics

REST
Stop offending activity / avoid using are / use immobiling techniqiues

ICE
Post Injury: Apply for first 12-24 hours = 10 min 4-6x a day
Non-Acute: use HEAT/moist heat for 20 min every 2-4 hours
do not use on INFLAMMED areas or w/ counter irritants

COMPRESSION
use bandages / wraps

ELEVATION
elevate injured area @/above level of heart

18

Counter-Irritant External Agents

general info

Prduce acute analgesic benefit in appropriate musculoskeletal conditions
minimal efficacy for chronic pain

4 GROUPS

Although all are applied topically:
there is some systemic absorption
serious toxicity after EXCESSIVE use esp in children
<2 y/o, no FDA approved agents

19

RUBEFACIENTS

Group A

External Analgesics

Produce redness & warmth with mild inflammation due to
VASODILATION
"rubefAAAcients" = redness/warmth/inflammation

Methyl Salicylate
(wintergreen oil)
may have systemic effects,
 DNU in children + asprin/salicylate ALLERGY

Other agents:
Ammonia water / allyl isothiocyanate / turpentine oil = Vicks/Sloans

20

Group B

External Analgesics

Produce COOLING SENSATION
"B-Cool"

Menthol
commonly used on its OWN = Bengay / biofreeze

Camphor
typically used w/ menthol = tiger balm 
smell / avoid use in infants / young children

21

Group C

External Analgesics

Induce VASODILATION 
"vasCodilation"

Histamine Dichloride
Australian dream pain relief

Methyl Nicotinate
found in new combo products

22

Group D

External Analgesics

Substance P Depletors
"D-epletors"
do NOT cause redness / vasodilation
Acute use --> release substance P = NT for pain perception
Chronic use --> depletes substance P = decreased pain perception

 

CAPSAICIN / Capsicum / Capsicum olersin
Zostrix / Capzasin HP Lotion / Cream

23

Substance P Depletors

Indications

Depletors = Group D external analgesics

Acute use: found in combo products, limited data
Chronic Disorders
DM Neuropathy / Post-Herpetic Neralgia (shingles=herpesZ)

Arthritic Conditions = reduce PAIN, not inflammation
only for HAND OA 

24

Substance P Depletors

Instructions

Depletors = Group D for CHRONIC USE:

Apply 3-4 times QD on a SCHEDULED BASISnot PRN

onset is SLOW
Arthritis pain = 1-2 weeks
Neurologic Pain = 2-4 weeks

pain relief MAY persist for several weeks AFTER d/c
may INITIALLY cause increased pain/burning = 72 hours

DO NOT USE ON BROKEN SKIN

25

Product SELECTION guidelines for:

External Analgesics

do NOT select products w/ ingredients from the same class/group
except for MENTHOL + CAMPHOR = Group B-cool

READ LABELS carefully
​many brand line extensions w/ diff ingredients
look for both active & inactive ingredients
can be problematic if h/o of allergies / ADR

DO NOT USE Counterirritants w/
Topical anesthetics / antipruritics / skin protectants

 

26

Trolamine Salicylate

External Analgesics

Found in Aspercreme / Blue-emu


OTC CAT 3 for efficacy, might have systemic absorption

 

Has same DI's as SALICYLATES
avoid in patient with ANTICOAGS / OTHER salicylates

27

Topical NSAIDS

External Analgesics

Diclofenac = RX only, only FDA-approved agent

Allows for localized NSAID treatment
similar benefit to ORAL NSAID

AAA BID
rash / topical pruritis
expensive = cos issue

28

Formulation Considerations of 

External Analgesics

Liniment / Ointment
application w/ friction or massage = therapeutic benefit

Gel
increased warmth / systemic absorption

Lotion
RAPID / uniform application + okay for hairy areas

Patch
up to 4 patches /24 hours

Spray
easy application to large areas

29

Patient Education

External Analgesics

do NOT apply to broken skin
or use with heating pads / hot water bottles / heat wraps

do NOT bandage tightly occlusion

overuse can lead to blistering

D/C if symptoms of HYPERsensitivity

KEEP OUT OF REACH OF CHILDREN