Pain patches for rheumatoid arthritis
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Pain patches for pain relief can be divided into non-narcotic and narcotic types.
One patch that is used for localized pain is the Lidoderm patch. This contains a 5% solution of lidocaine. The patch can be cut to size and comes in a resealable pouch.
While it hasn’t been used extensively for rheumatoid arthritis, it has been used for osteoarthritis and may also be beneficial for patients who have RA.
People who suffer from osteoarthritis of the knee may not need to rely on potentially risky cox-2 drugs to alleviate their pain. A simple patch placed on the affected area may provide comparable relief, results of a new study suggest. The study compared the efficacy and safety of Lidoderm, a transdermal patch containing five percent lidocaine, with celecoxib, popularly known by the brand name Celebrex. At six weeks, patients using the patch experienced similar relief from pain as those who were taking celecoxib, according to Dr Alan Kivitz, founder of the Altoona Center for Clinical Research in Duncansville, Pennsylvania, and a co-author of the study.
That observation could lead to an appealing treatment alternative for millions of people who suffer from osteoarthritis of the knee, he said.
"For me, the most important thing is to have [treatment] options available," Kivitz said Wednesday during a teleconference sponsored by the American Pain Foundation, a non-profit advocacy group based in Baltimore.
Researchers were to present the findings late Wednesday at the 24th annual scientific meeting of the American Pain Society in Boston. Endo Pharmaceuticals Inc., maker of the Lidoderm patch, funded the study.
Initially, investigators intended to enroll a total of 200 patients in a randomized, open-label study comparing lidocaine and celecoxib. But in November 2004, Endo Pharmaceuticals voluntarily halted the study before it was fully enrolled because of concerns about the safety of cox-2 inhibitors.
Consequently, the results are preliminary, Kivitz cautioned.
A total of 143 patients suffering from osteoarthritis of one or both knees were enrolled in the study before its termination. Sixty-nine received lidocaine patches; 74 were treated with 200-milligram celecoxib.
After six weeks of treatment, 54 percent of the lidocaine patients and 62 percent of the celecoxib patients experienced a 30 percent or greater improvement in pain intensity.
"This is what we call clinically meaningful," Kivitz said.
As with any FDA-approved medication, physicians are free to prescribe the lidocaine patch for osteoarthritis of the knee. It would be considered an "off-label" use, since the therapy is not approved for that purpose.
And while further research is needed to bear out the safety and effectiveness of this approach, Kivitz said the findings should give patients hope that other pain-relief options are being explored. "It's meant to give encouragement," he said. –
Other patches contain various mixtures of compounds such as mentholatum, eucalyptus, or capsaicin.
Another option is the Flector patch which contains Voltaren, an anti-inflammatory drug. While not approved for use in rheumatoid arthritis, it still may be helpful in some instances.
There is a new way of administering it in the form of glucosamine sulphate gel patches, which help ensure that it goes directly to the areas of your body that need it most.
These were inspired by the consumer craze in Japan for delivering all sorts of medication to the body via patches. The patches are designed to be an extra, rather than an alternative, way of taking glucosamine sulphate internally. Unlike the oral supplements, they are designed specifically for short-term use for soothing acute flare-ups of joint pain. This makes them especially useful for sports injuries and strains. The patches don't just contain glucosamine sulphate alone. They are also made up of two additional ingredients: menthol, which has a cooling and soothing effect, and horse chestnut, which acts as a natural anti-inflammatory.
The gel in the patches was developed at the School of Pharmacy and Biomolecular Services at the University of Brighton, and contains two per cent glucosamine, 0.1 per cent horse chestnut and 0.5 per cent menthol.
Although these might seem like miniscule amounts of the active ingredients, they are all that is in fact required to ensure the effective absorption by the body according to Dr Neil Barnes, an expert in hydrogel patch technology who helped develop the glucosamine gel patches.
Dr Barnes, says: "The patch is a very effective format for delivering ingredients via the skin", adding that, "if you have arthritic pain, you can place the patch wherever the pain is... the patches are skin-friendly and their safety record is extremely good."
Although small user trials have been carried out on the glucosamine gel patches (involving tens rather than hundreds of participants), the feedback of which has been very positive so far, there have not been any clinical trials performed as yet to test their efficacy. The patch has been developed based on an accumulation of knowledge already gleaned about its individual components and gel patch technology in general. However, it has been announced that the University of Glamorgan plans to carry out a double-blind, placebo-controlled trial on ex-sportsmen and women who suffer from mild to moderate arthritis, in about six months' time.
The Duragesic patch, which contains the generic drug Fentanyl, is a narcotic analgesic painkiller used for arthritis pain relief. The medication is absorbed directly from the patch when applied to the skin.
Fentanyl, a narcotic, relieves pain by acting on specific areas of the spinal cord and brain that process pain signals from nerves throughout the body.
Attach the patch to the skin using the dose recommended by your doctor. Replace the patch every 72 hours or as your doctor directs. To apply, remove the patch from its protective pouch and remove the liner from the sticky side of the patch. Place the patch on a site that is hairless and dry, and hold it in place for 10 to 30 seconds to ensure adhesion. Wash the area with water if necessary, but do not use soap, lotion, alcohol, or other substances that may irritate the skin. Do not apply it in the same place more than once within a 3-day period. Avoid any area that is burned, irritated, or excessively oily. Wash your hands after applying a new patch. Remove an old patch after 72 hours (3 days), fold it onto itself and dispose of it in the toilet. Fentanyl transdermal patches are available in the following concentrations: 25 micrograms per hour (mcg/hr); 50 mcg/hr; 75 mcg/hr; 100 mcg/hr.
The onset of effect is 12 to 24 hours. The duration of action is up to 72 hours.
Store the patch in its protective pouch away from heat, moisture, and direct light.
Apply a new patch as soon as you remember. Do not apply more than one patch at a time, unless directed to do otherwise by your doctor. Remove the patch 3 days after applying it.
The decision to stop using the drug should be made by your doctor. It may be necessary to reduce the dose gradually if the medication is used for a long time, to decrease the risk of suffering withdrawal symptoms.
Prolonged use may result in physical dependence.
Adverse reactions may be more likely and more severe in older patients. The smallest-dose patch is generally used at the beginning of therapy.
The use of fentanyl may impair your ability to perform such tasks safely.
Adequate human studies have not been done. Before taking fentanyl, discuss with your doctor the relative risks and benefits of using this drug while pregnant.
This drug passes into breast milk; avoid or discontinue using it while nursing.
This drug should not be used by patients under age 18 who weigh less than 110 pounds. Safety and effectiveness for children under the age of 12 have not been determined.
Do not alter your dose or suddenly stop using this drug without consulting your doctor. Abruptly stopping its use may cause withdrawal symptoms. Heat can cause fentanyl to be absorbed more rapidly. Avoid heating pads, sunbathing, or long showers or baths in hot water. Not recommended for postoperative pain.
Seizures, severe drowsiness, hallucinations, slow heartbeat, very slow or weak breathing, cold, clammy skin, pinpoint pupils of eyes.
Call your doctor, emergency medical services (EMS), or the nearest poison control center immediately.
Consult your doctor for specific advice if you are taking benzodiazepines; central nervous system depressants such as opiates, barbiturates, and tranquilizers; or antidepressants, amiodarone, clonidine, or MAO inhibitors.
There are no known food interactions.
Consult your doctor if you have any of the following: liver disease, kidney disease, prostate problems, gallbladder disease, intestinal problems such as colitis, underactive thyroid, brain tumor, any heart disease, anemia, or a history of alcohol or drug abuse. Fever may increase the rate at which the drug is absorbed by the body, thus increasing risk of overdose.
Another narcotic type patch is the Butrans once a week patch that contains buprenorphine. Butrans is indicated for the management of moderate to severe chronic pain when a continuous, around-the-clock opioid analgesic is needed for an extended period of time. Since it is a narcotic, all the precautions regarding the use of narcotics need to be followed.
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