Topical Analgesics for Neuropathic Pain in the Elderly
Elderly patients exhibit a higher incidence of several neuropathic pain conditions than younger individuals. Neuropathic pain can result from diabetes, shingles, or injury. Systemic treatment of neuropathic pain in the elderly usually requires lower dosing, slower titration, and more monitoring for efficacy and adverse effects than in younger patients. Drugs are absorbed and eliminated at different rates as people age, and as patients become frail, develop various illnesses, and take multiple medications, the risks of drug therapy increase. Conventional treatment of neuropathic pain is not optimal with less than 50% of patients achieving satisfactory pain relief. Adverse side effects can limit the dose that can be safely administered, and it may be lower than the dose needed to relieve pain.
When used to treat neuropathic pain, topical analgesics can produce pain relief that is comparable to that of oral agents, but typically cause fewer side effects (the most common being localized skin reactions) and fewer drug interactions. Topical analgesics may be used as alternative analgesics (when oral or injectable analgesics are not tolerated or not options) or as add-on analgesics when an oral agent produces a partial effect (the addition of an appropriate topical analgesics should not increase the side effects).
Our compounding pharmacists work together with physicians and other health care providers and their patients to customize medications to treat a specific problem. Preparations may contain one medication or a synergistic combination of medications, in the best dose and the most appropriate base depending on the site of application for topical preparations. We are happy to work with you to answer your questions and develop solutions for your medication problems.
Drugs Aging. 2014 Dec;31(12):853-62.