A Conceptual Study of Upanaha Swedana

Swedana Karma is undertaken by inducing sweating from the application of heat. There are many methods used to achieve this, with Upanaha Swedana being one of them. Upanaha Swedana is a standard treatment modality used in Ayurveda for the management of pain and inflammation. It is a localized treatment wherein a combination of medicinal drugs are prepared, made into a poultice, heated and applied at the affected site. This is meant to reduce the local inflammation and act as a topical analgesic. The procedure is divided into three phases which are: Purva Karma (pre-therapy procedures), the preparation of the Upanaha Swedana material is done, Pradhana Karma (main therapeutic procedures) the prepared Upanaha Swedana material is applied to the patient and Paschat Karma (post-therapy procedures) after waiting the specified times, the Upahana Swedana is removed following proper procedures. The present conceptual study was done based on the need of the day to elaborate the process of conducting Upanaha Swedana. For this, various Ayurvedic texts, digital libraries referencing Samhita were searched and the following headings were selected, types of data, types of reports and functionalities. This article seeks to explore this treatment modality and outline the general approach to be followed while conducting the procedure of Upanaha Swedana.

Analysis of over-the-counter analgesics purported to contain mescaline from the peyote cactus (Lophophora williamsii: Cactaceae)

The purpose of this study was to investigate samples of commercial over-the-counter products purported to contain extracts from peyote cactus (Lophophora williamsii), a vulnerable species. Samples were extracted with organic solvent and then washed to remove impurities. The extracts of these products were subjected to an analysis by real-time mass spectrometry (DART-MS) to determine the presence or absence of the alkaloid mescaline (3,4,5-trimethoxyphenethylamine). High-performance liquid chromatography (HPLC) was used to determine mescaline concentrations in the samples and to provide quantitative evidence of the concentration—if any—of mescaline in the products. If a detectable level of mescaline—a stable and abundant alkaloid of L. williamsii—was found in a given extract, then it was inferred that L. williamsii was present in the corresponding topical product. The results of this investigation show that most consumers who purchase the products in question are being defrauded if they believe they are buying L. williamsii-based medicines. The lack of mescaline—implying the lack of peyote—in these products suggests that wild populations of the vulnerable cactus L. williamsii, though currently being decimated on a massive scale in Mexico and the U.S. for other purposes, are rarely harvested for use in topical analgesic products. This conclusion is based on the finding that less than 5% of the ostensible L. williamsii-containing topical analgesic products that were analyzed in this study actually contained mescaline.

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.

Dermal delivery of amitriptyline for topical analgesia

Amitriptyline, administered orally, is currently one of the treatment options for the management of neuropathic pain and migraine. Because of the physicochemical properties of the molecule, amitriptyline is also a promising candidate for delivery as a topical analgesic. Here we report the dermal delivery of amitriptyline from a range of simple formulations. The first stage of the work required the conversion of amitriptyline hydrochloride to the free base form as confirmed by nuclear magnetic resonance (NMR). Distribution coefficient values were measured at pH 6, 6.5, 7, and 7.4. Solubility and stability of amitriptyline were assessed prior to conducting in vitro permeation and mass balance studies. The compound demonstrated instability in phosphate-buffered saline (PBS) dependent on pH. Volatile formulations comprising of isopropyl alcohol (IPA) and isopropyl myristate (IPM) or propylene glycol (PG) were evaluated in porcine skin under finite dose conditions. Compared with neat IPM, the IPM:IPA vehicles promoted 8-fold and 5-fold increases in the amount of amitriptyline that permeated at 24 h. Formulations containing PG also appear to be promising vehicles for dermal delivery of amitriptyline, typically delivering higher amounts of amitriptyline than the IPM:IPA vehicles. The results reported here suggest that further optimization of topical amitriptyline formulations should be pursued towards development of a product for clinical investigational studies. Graphical abstract

Herbal Topical Analgesic for Pain Management: Perspectives from Cancer Patients

Objective Herbs and natural products are increasingly used by cancer patients for pain management, but few studies have examined their integration within conventional cancer care. This study describes the characteristics, experiences, and perspectives of cancer patients who were prescribed a herbal topical analgesic for pain management. Design and Setting Program evaluation of a pilot herbal dispensary at a National Cancer Institute (NCI)-designated comprehensive cancer center. Subjects Cancer patients who were prescribed the Tibetree Pain-Relieving Plaster (PRP) by an integrative medicine physician. Methods Socio-demographic and clinical characteristics of patients were abstracted from medical records. Semi-structured phone interviews were conducted 1–2 weeks after PRP prescription to evaluate patient experiences with using PRP for pain. Interviews were analyzed using thematic content analysis. Results From February 2019 to February 2020, 50 patients were prescribed PRP. Median age (range) was 63 years (21-86), 37 (74%) of patients were female, 14 (28%) were non-White, and 38 (76%) of patients were using oral analgesics. During interviews, the majority of patients reported that the PRP improved pain and health-related outcomes, was convenient to use, and addressed pain management needs that were not fulfilled by oral analgesics. However, a few patients described adverse experiences with PRP, including skin irritation. Conclusions Understanding patient experiences and perspectives is a critical step towards evidence-based integration of herbs and natural products into cancer pain management. Findings from this program evaluation will inform the design of a randomized clinical trial on the efficacy and safety of PRP for pain in patients with cancer.