title: Novel Treatment of Radicular Pain With a Multi-Mechanistic Combination Topical Agent: A Case Series and Literature Review.
abstract: BACKGROUND
  Pharmacologic treatment of radicular pain with oral medications is limited by adverse effects and concern for dependence. While topical formulations have been explored in pain research, there is no published literature evaluating the efficacy in radicular pain. We present the first three cases of radicular pain successfully treated with a topical formulation of diclofenac, ibuprofen, baclofen, cyclobenzaprine, bupivacaine, gabapentin, and pentoxifylline (T7).
  
  
  METHODS
  Case series evaluating T7 for treatment of radicular pain in a single, outpatient pain center. Pain was rated on the numeric rating scale (NRS) on initial evaluation and follow up after a trial of T7. One to two grams of T7 was applied to the affected area 3 - 4 times daily in addition to the patient's baseline pharmacologic management. Three patients with median age of 50 (range, 39 to 65) and diagnosis of cervical and/or lumbosacral radicular pain participated. Two of the three had chronic radicular pain despite use of analgesic agents, spinal injections and failed spinal surgery syndrome. Each reported subjective improvement in radicular pain, function and sleep. There was an average decrease in NRS score consistent with 30% - 40% global improvement in symptoms, clinically significant based on the minimal clinically important difference for radicular pain. T7 was well tolerated without adverse reactions. Surgery was prevented or delayed in all cases.
  
  
  CONCLUSIONS
  This is the first report of the successful treatment of radicular pain with a topical agent. This highlights the need for randomized, prospective study of both single and compounded topical agents for treatment of radicular pain.
authors.affiliation: Department of Physical Medicine and Rehabilitation, The Rehabilitation Institute of Chicago, Northwestern Feinberg School of Medicine, Chicago, USA.
authors.forename: Pegah
authors.initials: P
authors.lastname: Safaeian
authors.affiliation: Department of Orthopaedics, Stanford University, Palo Alto, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Mattie
authors.affiliation: Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hahn
authors.affiliation: Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Plastaras
authors.affiliation: Department of Physical Medicine and Rehabilitation, The Rehabilitation Institute of Chicago, Northwestern Feinberg School of Medicine, Chicago, USA; Department of Anesthesiology, Northwestern Feinberg School of Medicine, Chicago, USA.
authors.forename: Zachary L
authors.initials: ZL
authors.lastname: McCormick
keywords: Administration; Anesthetics; Neuralgia; Radiculopathy; Topical