Some patients do not tolerate these drugs and some find them ineffective, which may cause a significant drop in patient compliance. However, oral therapy requires multiple medications taken at varying times of the day and is often associated with a significantly elevated risk of systemic side effects, which may be severe ( 18). Oral agents, such as amitriptyline, duloxetine, pregabalin and gabapentin, are recommended as first-line drug treatments ( 17). At present, the pharmacological treatments for DNP include oral and topical therapies ( 16). The management of DNP is challenging and can require a multi-modal approach involving early recognition, glycemic control and psychological therapy, as well as therapies for symptomatic pain relief ( 13– 15). Thus, treating this debilitating condition appropriately is important, particularly because of the impact on QOL and the associated depression and anxiety ( 12). The pain may also be associated with depression and may be a reason for withdrawal from recreational and social life ( 7, 10, 11). Neuropathic pain can be constant and accompanied by cutaneous allodynia, which significantly influences quality of life (QOL) and prevents patients from performing their daily activities and roles of employment. The more severe occurrences of DNP can be intractable ( 8, 9). Diabetic neuropathic pain (DNP) is among the most common, expensive and disabling complications of diabetes, affecting approximately 30% of patients with diabetes who are hospitalized and 25% of those in the community ( 5, 6).ĭNP is characterized by sensations of numbness, burning pain and prickling or stinging around the hands and feet, and the pain is more severe at night ( 7). A population-based study indicated that up to 50% of patients with either type 1 or type 2 diabetes develop diabetic neuropathy ( 3), and 15–30% of those manifestations are painful ( 4). Diabetic neuropathy is the most common complication of diabetes mellitus, becoming symptomatic after 14.5 years of chronic prolonged high blood glucose in type 1 diabetes, and after only 8.1 years in type 2 diabetes ( 2). The findings indicate that developing topical drugs acting on different targets in the process of DNP is a valuable area of future research.Īccording to the International Diabetes Federation, there are 425 million adults with diabetes worldwide ( 1). Compounded topical agents are also effective and safe for patients with DNP and could be another area worthy of further investigation based on the strategy of using low-dose, complementary therapies for DNP. It has been indicated that these topical drugs have the potential to be valuable additional options for the management of DNP, with adequate safety and continuous long-term treatment efficacy. ![]() Furthermore, the potential efficacy of these treatments is addressed according to the available clinical research literature. In the present review, a summary is provided of the available agents for topical use in patients with DNP, including lidocaine plasters or patches, capsaicin cream, gel or patches, amitriptyline cream, clonidine gel, ketamine cream, extracts from medicinal plants including nutmeg extracts and Citrullus colocynthis extract oil, and certain compounded topical analgesics. Topical use of drugs as an alternative option for DNP treatment is currently gaining interest. Oral treatment is the most frequently used method for DNP, but its use is often limited by systemic side effects. In addition, it can improve the patients' comfort and quality of life.Diabetic neuropathic pain (DNP) has a huge impact on quality of life and can be difficult to treat. ![]() Local dermal application of the compound lidocaine cream can be used as an alternative to the systemic morphine administration in cancer wound care for its safety and effectiveness. ![]() The means for the pain score and heart rate of the topical lidocaine/prilocaine cream group were lower than those of the morphine group (P<0.01) and the Kolcaba comfort level was higher (P<0.01). VAS scores, heart rate, and Kolcaba comfort level were recorded for the two groups 10 min before and 10, 15, 20, and 25 min after wound care and data were analyzed statistically. ![]() Before wound care, 60 patients were randomly divided into 2 groups of 30 each: morphine group (10 mg tablet) topical 5% compound lidocaine cream group (0.2 g/cm2). All patients were enrolled with a visual analog scale (VAS) pain score ≥4. The aim of this study was to explore the analgesic effect of local application of compound lidocaine/prilocaine cream on cancer wounds during wound care in order to reduce the amount of morphine intake or completely replace the systemic morphine administration and optimize the protocol for cancer wound pain management.
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