title: Topical treatment in pain medicine: from ancient remedies to modern usage.
abstract: Over several millennia, substances have been applied to the skin for treatment of pain. Some ingredients are in current use; others have been discontinued. Mechanisms of action include interactions with nociceptive neural networks and inflammatory processes. Substances must penetrate the stratum corneum barrier and vehicles that enhance penetration have been developed. Topical drugs with links to the past include menthol, capsaicin, some opioids, local anesthetic agents and NSAIDs. Mandragora is also described as an example of a herbal remedy that has been discontinued due to its toxicity. The future for topical drugs is promising, with the advent of new drugs tailored for specific pain mechanisms and the development of both penetration enhancers and sterile preparation methods.
authors.affiliation: Perth Pain Management Centre, Perth, Western Australia, Australia.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Finch
authors.affiliation: Centre for Research on Chronic Pain & Inflammatory Diseases, Murdoch University, Perth, Western Australia, Australia.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Drummond
mesh_terms: D000279:Administration, Cutaneous; D000639:Amitriptyline / Q000008:administration & dosage / Q000627:therapeutic use; D000700:Analgesics / Q000008:administration & dosage* / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D002211:Capsaicin / Q000008:administration & dosage / Q000627:therapeutic use; D003000:Clonidine / Q000008:administration & dosage / Q000627:therapeutic use; D003042:Cocaine / Q000008:administration & dosage / Q000627:therapeutic use; D004817:Epidermis / Q000187:drug effects / Q000502:physiology; D049671:History, 18th Century; D049673:History, 20th Century; D049674:History, 21st Century; D049690:History, Ancient; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage / Q000627:therapeutic use; D026781:Mandragora; D008610:Menthol / Q000008:administration & dosage / Q000627:therapeutic use; D059225:Nociception / Q000187:drug effects / Q000502:physiology; D059408:Pain Management / Q000266:history / Q000379:methods*; D010936:Plant Extracts / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000700:Analgesics; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D010936:Plant Extracts; D008610:Menthol; D000639:Amitriptyline; D007649:Ketamine; D003042:Cocaine; D003000:Clonidine; D002211:Capsaicin
keywords: antiquity; current agents; mechanisms; receptors; stratum corneum; topical drugs; vehicles