Topical Pain Relief - Diclofenac & Lidocaine

June 8, 2021

By Barret Procyshyn, Pharmacist at Dauphin Clinic Pharmacy

Topical Pain relief is usually in high demand. At the pharmacy a quite a few questions asking, "what can we use instead of pill for pain". Topical formulations can work very well. Also, they are not significantly systemically absorbed, so it can be a good option for those who find medications such as naproxen (Aleve) and ibuprofen (Advil) upset the stomach. Some topical pain treatment are available without a prescription, while we have various compounded formulations available in high strengths available with a doctor's prescription.

Most topical formulations for muscle injuries, joint pain and arthritis involve the ingredient diclofenac. Diclofenac is the ingredient used in the popular over the counter product Voltaren. Diclofenac is a non-steroidal anti-inflammatory medication, which provides an analgesic (pain reducing) action. It works at the site of pain and inflammation by reducing prostaglandin synthesis. The ingredient and its delivery system (gel/ointment/cream) may determine how effective the product is. Ideally you want a small medication particle size in a good absorbing vehicle to deliver better effectiveness. Make sure you receive a quality compounded topical, instead of a powder simply mixed into a cream.

While over the counter Voltaren is a good starting point, prescription pain compounds allow for a higher strength and potentially more effective product. If you have medication coverage, talk to your doctor about the possibility of getting a prescription for a topical pain reliever. It may be covered by your plan and save you a significant amount of money. While other pain relief formulations are available (RUB A535, Deep Cold, LIV pain relief), most of these only create a reaction on the skin to mask the pain rather than having a mechanism to treat it.

We also get questions about topical pain relief for other ailments. Lidocaine inhibits nerve impulses, thereby effecting local anesthetic action. If you are getting a tattoo, laser hair removal, piercing, waxing, injection, or other painful procedure you may want to consider topical lidocaine. A new product we carry is called Zensa, which contains 5% topical lidocaine. While this product is available without a prescription, we keep it behind the pharmacy counter, so be sure to talk to your clinic pharmacist. While other topical lidocaine is available, like the Emla formulation, Zensa is gaining popularity for a few reasons. It is a water-based formulation allowing for quick onset of action, in as little as 15-20 minutes. Emla is reported to require up to 45 minutes. Zensa has a neutral pH so it works on sensitive areas. Also, because of the water-based formulation, any excess product remaining on the skin at the time of the procedure can be wiped off without any oily or greasy residue.

I am no tattoo expert by any means; however, it apparently has no effect on ink settlement or retention. We do have some local artists who recommend it. It can be applied after the tattoo is completed to reduce pain.

For pharmaceutical uses, lidocaine (Zensa) has indications for adult shingles or hemorrhoids to attain pain relief. There is not much available for over-the-counter shingles treatment, so it may be worth a try. With health provider advice, it can also be used for pain reduction for injections, mole removals and skin tag removals. It is safe to be used on pregnant women and children two years and above. While steroid creams and anti-inflammatory creams should not be used on broken skin or open wounds, lidocaine is shown to be safe. Another benefit to Zensa, is it is cost effective compared to other formulations on the market.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist, or other health care professional.

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