Other Topical Agents

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Other agents have also been studied in these conditions. There was no benefit of 0.025 percent capsaicin cream over vehicle (not active) cream in a randomized, doubleblind study of 30 patients with pain in the tempor-omandibular joint.75[II] A randomized controlled study of a topical cream containing glucosamine sulfate, chondroitin sulfate, and camphor for osteoarthritis of the knee showed a significant reduction of pain in the treatment group after eight weeks compared to the placebo group.76[II] To date, no randomized controlled trial results have been published regarding the use of a topical local anesthetic agent in the treatment of an acute soft tissue injury or in the treatment of osteoarthritis;

however, two anecdotal reports of the use of the lidocaine 5 percent patch for an acute sports injury are of novel interest. A professional basketball player with a liga-mentous strain in his left fifth toe was advised by the team doctor to use the lidocaine 5 percent patch for pain relief with a good outcome and a professional football player with chronic acromioclavicular joint pain due to a dislocation was anecdotally reported to experience pain relief with use of the lidocaine 5 percent patch as well. The basis for using such an agent in this setting may be the awareness that local anesthetics do in fact have anti-inflammatory properties.

A recently published case series has reported the potential benefit of "topical" morphine in the management of chronic osteoarthritis-related pain; however, the report did emphasize that morphine or its metabolites were identifiable in the urine of treated patients, hence calling into question just how truly "topical" this preparation was.77[V]

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