The validity of topical drug therapy for otitis media with effusion

Otitis media with effusion is difficult to diagnose, since the course of the disease is mostly asymptomatic, while the initial stage of the disease is very similar to Eustachiitis or the pre-perforative stage of acute otitis media. At this stage, dysfunction of the auditory tube and negative pressure in the tympanic cavity creates the conditions for the production of transudate, which clinically, in addition to hearing loss, is accompanied by soreness, a feeling of congestion, pressure, fluid transfusion in the ear. When conducting local medical procedures, they are primarily guided by the condition of the mucous membrane of the eustachian tube, nasopharynx and nasal cavity, but changes in the eardrum are no less important. Thus, the use of topical analgesics with an anti-inflammatory effect becomes no less relevant in the treatment.A literature review was carried out with an analysis of scientific research data on the use of a topical combination drug that has a local anesthetic and anti-inflammatory effect in the treatment of diseases of the external and middle ear.Analysis of the literature showed that the use of lidocaine-phenazone-containing drops promotes rapid regression of the inflammation in the external auditory canal and the tympanic membrane, as well as relieving of pain. It can be used both in children (including newborns) and in adults who are suffering from otitis media but with intact tympanic membrane, including otitis media with effusion.Combined topical drugs containing lidocaine-phenazone demonstrate efficacy and safety in the treatment of catarrhal and otitis media with effusion in all age groups.

Construction of lidocaine transmembrane nano-liposomes and preliminary study on its surface anesthetic effect

Lidocaine (Lido) is an amide local anesthetic that has both excitatory and inhibitory effects on the central nervous system, and is one of a group of commonly used local nerve block drugs that are used in the clinic. However, traditional Lido does not meet the transdermal performance requirements of surface anesthetic agents for treating pain in patients. Optimizing the preparation of a Lido transdermal preparation and improving the control of anesthetic depth and efficiency has become a challenge in the field of topical anesthesia. In this study, a new type of Lido nano-transdermal preparation, carboxymethyl chitosan-modified lidocaine liposomes (Lido-CMCSNLP), were constructed based on nano-liposomes. Carboxymethyl chitosan can enhance the permeability of hydrophilic macromolecular pathways by interacting with negatively charged membrane glycoproteins, which is beneficial for the transdermal absorption of Lido. Therefore, Lido-CMCS-NLP provides a new approach for research in clinical topical anesthesia and perioperative topical analgesics.

AB0592 ASSESSMENT OF KNOWLEDGE OF THE APPLICATION OF TOPICAL ANALGESICS

Background:In chronic osteoarticular pain, especially knee osteoarthritis, topical analgesics and topical non-steroidal anti-inflammatory drugs represent an interesting therapeutic alternative for patients with several comorbidities in order to avoid side effects and medical interactions.Objectives:The aim of this work was to assess how patients apply a topical analgesic.Methods:A prospective study has been conducted over a period of 4 weeks. Sixty-six patients followed for knee osteoarthritis at different stages of the disease and under topical analgesic treatment were integrated into this study. Epidemiological data, physical examination and x-ray data were collected. The impact of knee osteoarthritis was evaluated by the Lequesne and WOMAC indices. Patients were asked about how long they apply the treatment, how often they use the treatment per week and whether they are massaging the aching area while applying the treatment.Results:In the studied population, the majority of patients were women (87%) with an average age of 55 years. Forty percent of the patients were illiterate as long as 21% received a college education. Patients’ occupations were distributed as follows: 59% housewives, 21% retirees, 12% manual occupations and 8% non-manual occupations.The most common comorbidities were high blood pressure (61%), diabetes (38%) and osteoporosis (36%).The average duration of development of osteoarthritis of the knee was 9 years. The most common radiological stage was stage 1 (58%). The site was femorotibial in 88% of cases, patellofemoral in 4% of cases and bi or tri-compartmental in 8% of cases. The osteoarthritis most often affected both knees: 86% of casesThe average of the Lequesne index was 11. The average WOMAC index was 12 for pain, 1.5 for stiffness and 48 for dysfunction.All the interviewed patients were on topical analgesics for an average of 5 years.The average frequency of application of topical analgesics was 9 times per week. Housewives and retirees used the treatment on average 14 times per week while working patients use the treatment on average 5 times per week. Seventy-two percent of patients reported that they performed an average massage lasting 11 minutes with each application.Among patients with secondary and university education, 64% of patients reported that they performed a massage on the painful knee while applying the medication.Patients followed for knee osteoarthritis for more than 10 years tend to apply the local analgesic for a shorter period of time (an average of 5 minutes).Conclusion:Patients followed for osteoarthritis of the knee who are taking topical analgesics tend to make misuse, including massaging for a long time and applying treatment less frequently than recommended. The level of education does not seem to play a role in knowing the right way to apply. However, patients who have been followed for a longer period for knee osteoarthritis use the treatment more correctly.References:[1]Flores MP, Castro AP, Nascimento Jdos S. Topical analgesics. Rev Bras Anestesiol. 2012 Mar-Apr;62(2):244-52. doi: 10.1016/S0034-7094(12)70122-8. PMID: 22440379.[2]Barkin RL. The pharmacology of topical analgesics. Postgrad Med. 2013 Jul;125(4 Suppl 1):7-18. doi: 10.1080/00325481.2013.1110566911. PMID: 24547599.Disclosure of Interests:None declared.

AB0593 PERCEPTION OF THE EFFECTIVENESS OF TOPICAL ANALGESICS IN PATIENTS WITH OSTEOARTHRITIS OF THE KNEE

Background:Osteoarthritis of the knee is one of the most common joint diseases. It mainly manifests as pain and can become disabling over time. Several symptomatic therapeutic methods are used to relieve patients with knee osteoarthritis and give them more autonomy. Topical analgesics are considered as an interesting alternative for old and poly-medicated patients.Objectives:The aim of this work was to assess the perception of the effectiveness of topical analgesics by patients followed for knee osteoarthritis.Methods:A prospective study has been conducted collecting 66 patients followed for knee osteoarthritis at different stages of the disease and under topical analgesic treatment. Epidemiological data, physical examination and x-ray data were collected. The impact of knee osteoarthritis was evaluated by the Lequesne and WOMAC indices. Patients were asked to evaluate their perception about: the time that makes the medication to act, the duration of action and overall satisfaction with the topical analgesic by rating it from 0 to 5. Zero represents complete dissatisfaction while 5 represents complete satisfaction. Patients were also asked about the side effects observed after the use of the topical treatment and whether they recommended this treatment to a friend or a parent.Results:In the studied population, the majority of patients were women (87%) with an average age of 55 years. The most common comorbidities were high blood pressure (61%), diabetes (38%) and osteoporosis (36%). Sixty-nine percent of patients were taking more than two oral treatments. The average duration of development of osteoarthritis of the knee was 9 years. The most common radiological stage was stage 1 (58%). The site was femorotibial in 88% of cases, patellofemoral in 4% of cases and bi or tri compartmental in 8% of cases. The osteoarthritis most often affected both knees in 86% of cases.The average of the Lequesne index was 11. The average WOMAC index was 12 for pain, 1.5 for stiffness and 48 for dysfunction.All the patients surveyed were on topical non-steroidal anti-inflammatory drugs (NSAIDs), 37.7% combined local herbal medicine with local NSAIDs, 53% were taking oral analgesics, and 19% were using oral non-steroidal anti-inflammatory drugs in the past month.The average rating for time that takes the topical treatment to act was 2.9, for duration of action was 1.2, and for overall satisfaction was 2.8. No adverse effects of topical treatment have been reported.For patients over 60 years old, better satisfaction was noted (the average score for overall satisfaction was 3.2).Patients with a WOMAC Pain Index greater than 10 were less satisfied (the average overall satisfaction score was 1.1). Patients who took both topical NSAIDs and topical herbal medicine reported that topical NSAIDs were more effective in 66% of cases. Forty percent of patients recommended topical treatment to a friend or a family member.Conclusion:In patients with chronic pain associated to osteoarthritis of the knee, topical analgesics are considered a good long-term therapeutic alternative. Patients are generally satisfied with the effectiveness of the local treatment, in particular the immediate effect felt after application, but less satisfied with the duration of action. Perception of effectiveness appears to be affected by age and degree of pain.References:[1]D. Y. Wall, “Topical Nonsteroidal Anti-Inflammatory Drugs for Chronic Musculoskeletal Pain in Adults,” p. 3, 2017.[2]R. L. Barkin, “The Pharmacology of Topical Analgesics,” null, vol. 125, no. sup1, pp. 7–18, Jul. 2013, doi: 10.1080/00325481.2013.1110566911.Disclosure of Interests:None declared.

Peripheral Mechanisms of Neuropathic Pain—The Role of Neuronal and Non-Neuronal Interactions and Their Implications for Topical Treatment of Neuropathic Pain

Neuropathic pain in humans arises as a consequence of injury or disease of somatosensory nervous system at peripheral or central level. Peripheral neuropathic pain is more common than central neuropathic pain, and is supposed to result from peripheral mechanisms, following nerve injury. The animal models of neuropathic pain show extensive functional and structural changes occurring in neuronal and non-neuronal cells in response to peripheral nerve injury. These pathological changes following damage lead to peripheral sensitization development, and subsequently to central sensitization initiation with spinal and supraspinal mechanism involved. The aim of this narrative review paper is to discuss the mechanisms engaged in peripheral neuropathic pain generation and maintenance, with special focus on the role of glial, immune, and epithelial cells in peripheral nociception. Based on the preclinical and clinical studies, interactions between neuronal and non-neuronal cells have been described, pointing out at the molecular/cellular underlying mechanisms of neuropathic pain, which might be potentially targeted by topical treatments in clinical practice. The modulation of the complex neuro-immuno-cutaneous interactions in the periphery represents a strategy for the development of new topical analgesics and their utilization in clinical settings.

A Review on Mitigating Fear and Aggression in Dogs and Cats in a Veterinary Setting

A high proportion of dogs and cats are fearful during veterinary visits, which in some cases may escalate into aggression. Here, we discuss factors that contribute to negative emotions in a veterinary setting and how these can be addressed. We briefly summarise the available evidence for the interventions discussed. The set-up of the waiting area (e.g., spatial dividers; elevated places for cat carriers), tailoring the examination and the treatment to the individual, considerate handling (minimal restraint when possible, avoiding leaning over or cornering animals) and offering high-value food or toys throughout the visit can promote security and, ideally, positive associations. Desensitisation and counterconditioning are highly recommended, both to prevent and address existing negative emotions. Short-term pain from injections can be minimised by using tactile and cognitive distractions and topical analgesics, which are also indicated for painful procedures such as ear cleanings. Recommendations for handling fearful animals to minimise aggressive responses are discussed. However, anxiolytics or sedation should be used whenever there is a risk of traumatising an animal or for safety reasons. Stress-reducing measures can decrease fear and stress in patients and consequently their owners, thus strengthening the relationship with the clients as well as increasing the professional satisfaction of veterinary staff.

Protocol: mixed-methods study of how implementation of US state medical cannabis laws affects treatment of chronic non-cancer pain and adverse opioid outcomes

Background Thirty-three US states and Washington, D.C., have enacted medical cannabis laws allowing patients with chronic non-cancer pain to use cannabis, when recommended by a physician, to manage their condition. However, clinical guidelines do not recommend cannabis for treatment of chronic non-cancer pain due to limited and mixed evidence of effectiveness. How state medical cannabis laws affect delivery of evidence-based treatment for chronic non-cancer pain is unclear. These laws could lead to substitution of cannabis in place of clinical guideline-discordant opioid prescribing, reducing risk of opioid use disorder and overdose. Conversely, state medical cannabis laws could lead to substitution of cannabis in place of guideline-concordant treatments such as topical analgesics or physical therapy. This protocol describes a mixed-methods study examining the implementation and effects of state medical cannabis laws on treatment of chronic non-cancer pain. A key contribution of the study is the examination of how variation in state medical cannabis laws’ policy implementation rules affects receipt of chronic non-cancer pain treatments. Methods The study uses a concurrent-embedded design. The primary quantitative component of the study employs a difference-in-differences design using a policy trial emulation approach. Quantitative analyses will evaluate state medical cannabis laws’ effects on treatment for chronic non-cancer pain as well as on receipt of treatment for opioid use disorder, opioid overdose, cannabis use disorder, and cannabis poisoning among people with chronic non-cancer pain. Secondary qualitative and survey methods will be used to characterize implementation of state medical cannabis laws through interviews with state leaders and representative surveys of physicians who treat, and patients who experience, chronic non-cancer pain in states with medical cannabis laws. Discussion This study will examine the effects of medical cannabis laws on patients’ receipt of guideline-concordant non-opioid, non-cannabis treatments for chronic non-cancer pain and generate new evidence on the effects of state medical cannabis laws on adverse opioid outcomes. Results will inform the dynamic policy environment in which numerous states consider, enact, and/or amend medical cannabis laws each year.

Menthol-Based Topical Analgesic Induces Similar Upper and Lower Body Pain Pressure Threshold Values: A Randomized Trial

Context: Both health professionals and consumers use menthol-based topical analgesics extensively for the temporary relief of pain from musculoskeletal ailments or injury. However, there are no reports of differences in the pain pressure threshold (PPT) or the relative effectiveness of topical analgesics to reduce pain in the upper and lower body muscles and tendons. The objective of this study was to investigate whether differences existed in PPT and relative pain attenuation associated with a menthol-based topical analgesic over a variety of upper and lower body muscles and tendons. Design: Randomized allocation, controlled, intervention study. Methods: Sixteen participants (10 females and 6 males) were tested on their dominant or nondominant side. The order of specific muscle/tendon testing was also randomized, which included upper body (middle deltoid, biceps brachii, and lateral epicondylar tendon) and lower body locations (quadriceps, hamstrings, gastrocnemius, lumbosacral erector spinae muscles, and patellar and Achilles tendons). The PPT was monitored before and 15 minutes following the application of a menthol-based topical analgesic. Results: A menthol-based topical analgesic increased PPT (decreased pain sensitivity) overall (P = .05; 11.6% [2.4%]; d = 1.05) and PPT was higher (P < .0001; 31.5%–44.2%; d = 1.03–1.8) for lower versus upper body locations. Conclusions: Health professionals and the public can be assured of similar reductions in pain sensitivity independent of the location of application of a menthol-based topical analgesic.