Are Painkillers Through The Skin As Effective As Pills

Today's post from dailyrx.com (see link below) discusses whether topical creams and gels are as good as or better than analgesics in pill form. Many people find taking pills every day a difficult task and the rise in topical gel preparations provides a good alternative. The problem with topical gels and creams is that people have less trust in them than in a pill and have a tendency to over do the application, possibly leading to more of the drug being absorbed than is necessary. People living with neuropathy have long known about certain creams and patches which are meant to help with neuropathic symptoms but they too are not without controversy. Capsaicin cream and high strength patches can be painful and even cause burning and although many people have gained benefit from them, equally as many haven't. Because most people have symptoms in their feet and legs (or hands and arms), the topical creams can be applied at the source of the pain but the source of peripheral neuropathy pain can actually be elsewhere (in the spine or brain for instance); it's just the symptoms manifest themselves most commonly at the ends of nerve pathways (feet and hands). It's always advisable to get the best medical advice possible and ask to be monitored as to how these creams are working but with advances in preparations, they may well turn out to be effective alternatives to popping pills in the future.

Creams Versus Pills for Pain
Author Info: Charles E. Argoff, MD, of the Department of Neurology at Albany Medical College, Reviewed by: Joseph V. Madia, MD By:Laura Dobberstein March 2013


Pain relievers applied to the skin can be just as effective as those taken orally
(dailyRx News) Gel and cream pain relievers are gaining in popularity. This method of pain relief has fewer side effects than their pill counterparts and may work just as well.

A recent review looked at the use of pain relievers absorbed through the skin to manage pain.

The review found that the pain relieving medications diclofenac and ibuprofen were effective in treating muscle, tendon and ligaments and joint conditions like osteoarthritis when absorbed through the skin.

The medication lidocaine also effectively treated nerve-related pain when applied to the skin.
"Ask your doctor if topical analgesics are best."

Charles E. Argoff, MD, of the Department of Neurology at Albany Medical College, searched existing databases for studies on topical analgesics (pain relievers absorbed through the skin). Dr. Argoff identified a total of 65 studies that associated long-term, short-term and neuropathic pain with topical analgesics.

Neuropathic pain is a type of pain caused by nerve damage and often seen in patients with trauma, diabetes and amputations.

The most common drugs included in the studies were nonsteroidal anti-inflammatory drugs (NSAIDs) including diclofenac, ibuprofen, ketoprofen, piroxicam and indomethacin. The next most common drugs were lidocaine, capsaicin, amitriptyline, glyceryl trinitrate, opioids, menthol, pimecrolimus and phenytoin.

Eighteen of the studies used the pain relievers for short-term soft tissue injuries, 17 studies involved neuropathic pain and six involved pain induced for the purpose of the experiment only. Five of the studies used the pain relievers for long-term joint related conditions, five involved skin or leg ulcers and two used the medication for chronic knee pain.

Dr. Argoff concluded ibuprofen relieved chronic knee pain and short-term soft tissue injuries pain just as effectively when applied to the skin as when ingested.

The use of diclofenac topically to treat joint pain was shown in a study of temporomandibular joint disorder, a painful condition of the jaw. The study showed diclofenac applied to the skin worked just as well as when taken orally.

Lidocaine was the only drug in the studies that effectively relieved neuropathic pain.

No other drugs included in the review showed strong evidence of relief when used topically.

Pain relievers applied through the skin had fewer side effects, such as stomach and heart irritation, than orally administered pain relievers.

Dr. Argoff recommended the further study of NSAIDs and lidocaine for short-term and long-term pain relief.

The study was published in Mayo Clinic Proceedings.

Financial support for the study was provided by Mallinckrodt Inc., a company that manufactures pharmaceuticals and other health-related items.

Dr. Argoff is associated with over a dozen pharmaceutical companies and health research groups.

http://www.dailyrx.com/pain-relievers-applied-skin-can-be-just-effective-those-taken-orally

SCANNING BABIES FINGERPRINTS COULD SAVE LIVES THROUGH VACCINATION

Each year 2.5 million children die worldwide because they do not receive life-saving vaccinations at the appropriate time.

Anil Jain, Michigan State University professor, is developing a fingerprint-based recognition method to track vaccination schedules for infants and toddlers, which will increase immunization coverage and save lives.

To increase coverage, the vaccines must be recorded and tracked. The traditional tracking method is for parents to keep a paper document. But in developing countries, keeping track of a baby's vaccine schedule on paper is largely ineffective, Jain said.

"Paper documents are easily lost or destroyed," he said. "Our initial study has shown that fingerprints of infants and toddlers have great potential to accurately record immunizations. You can lose a paper document, but not your fingerprints."

Jain and his team traveled to rural health facilities in Benin, West Africa, to test the new fingerprint recognition system. They used an optical fingerprint reader to scan the thumbs and index fingers of babies and toddlers. From this scanned data, a schedule will be created and become a part of the vaccine registry system.

Once the electronic registry is in place, health care workers simply re-scan the child's fingers to view the vaccination schedule. They know who has been vaccinated, for what diseases and when additional booster shots are needed.

These new electronic registry systems will help overcome the lack and loss of information, which is the primary problem in the vaccine delivery system in third world nations, Jain said.

Collecting fingerprints from fidgety infants is not easy. Another challenge is their small fingerprint patterns have low contrast between ridges and valleys.

"The process can still be improved but we have shown its feasibility," Jain said. "We will continue to work on refining the fingerprint matching software and finding the best reader to capture fingerprints of young children, which will be of immense global value. We also plan to conduct a longitudinal study to ensure that fingerprints of babies can be successfully matched over time."

There will be other benefits in addition to tracking vaccinations, said Mark Thomas, executive director of VaxTrac, a nonprofit organization supporting Jain's research.

"Solving the puzzle of fingerprinting young children will have far-reaching implications beyond health care, including the development of civil registries, government benefits' tracking and education recordkeeping," Thomas said.

BRAIN SURGERY BY ROBOT THROUGH THE CHEEK

For those most severely affected, treating epilepsy means drilling through the skull deep into the brain to destroy the small area where the seizures originate -- invasive, dangerous and with a long recovery period.

Five years ago, a team of Vanderbilt engineers wondered: Is it possible to address epileptic seizures in a less invasive way? They decided it would be possible. Because the area of the brain involved is the hippocampus, which is located at the bottom of the brain, they could develop a robotic device that pokes through the cheek and enters the brain from underneath which avoids having to drill through the skull and is much closer to the target area.

To do so, however, meant developing a shape-memory alloy needle that can be precisely steered along a curving path and a robotic platform that can operate inside the powerful magnetic field created by an MRI scanner.

The engineers have developed a working prototype, which was unveiled in a live demonstration this week at the Fluid Power Innovation and Research Conference in Nashville by David Comber, the graduate student in mechanical engineering who did much of the design work.

The business end of the device is a 1.14 mm nickel-titanium needle that operates like a mechanical pencil, with concentric tubes, some of which are curved, that allow the tip to follow a curved path into the brain. (Unlike many common metals, nickel-titanium is compatible with MRIs.) Using compressed air, a robotic platform controllably steers and advances the needle segments a millimeter at a time.

According to Comber, they have measured the accuracy of the system in the lab and found that it is better than 1.18 mm, which is considered sufficient for such an operation. In addition, the needle is inserted in tiny, millimeter steps so the surgeon can track its position by taking successive MRI scans.

According to Associate Professor of Mechanical Engineering Eric Barth, who headed the project, the next stage in the surgical robot's development is testing it with cadavers. He estimates it could be in operating rooms within the next decade.

To come up with the design, the team began with capabilities that they already had. "I've done a lot of work in my career on the control of pneumatic systems," Barth said. "We knew we had this ability to have a robot in the MRI scanner, doing something in a way that other robots could not. Then we thought, 'What can we do that would have the highest impact?'"

At the same time, Associate Professor of Mechanical Engineering Robert Webster had developed a system of steerable surgical needles. "The idea for this came about when Eric and I were talking in the hallway one day and we figured that his expertise in pneumatics was perfect for the MRI environment and could be combined with the steerable needles I'd been working on," said Webster.

The engineers identified epilepsy surgery as an ideal, high-impact application through discussions with Associate Professor of Neurological Surgery Joseph Neimat. They learned that currently neuroscientists use the through-the-cheek approach to implant electrodes in the brain to track brain activity and identify the location where the epileptic fits originate. But the straight needles they use can't reach the source region, so they must drill through the skull and insert the needle used to destroy the misbehaving neurons through the top of the head.

Comber and Barth shadowed Neimat through brain surgeries to understand how their device would work in practice.

"The systems we have now that let us introduce probes into the brain -- they deal with straight lines and are only manually guided," Neimat said. "To have a system with a curved needle and unlimited access would make surgeries minimally invasive. We could do a dramatic surgery with nothing more than a needle stick to the cheek."

The engineers have designed the system so that much of it can be made using 3-D printing in order to keep the price low. This was achieved by collaborating with Jonathon Slightam and Vito Gervasi at the Milwaukee School of Engineering who specialize in novel applications for additive manufacturing.