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Patient Information for Stokes Pain Lotions These combination medications are used to provide pain relief by grouping multiple pain relievers in one lotion and delivering these medications via the transdermal route (through the skin). MEDICATION: Acyclovir- is an antiviral drug that is active against the herpes viruses, including herpes simplex 1 and 2 (cold sores and genital herpes) and varicella-zoster (shingles and chicken pox), and Epstein-Barr virus (mononucleosis). It is used in the treatment of shingles; it reduces pain, shortens the healing time, and limits the spread of virus and the formation of new lesions. Viruses take over living cells and reproduce themselves. Incorporation of active acyclovir into the new viral cell stops the production of the virus. Amitriptyline - is an anti-depressant medication that helps reduce pain and improve sleep.This medicine is reserved for long-term (chronic) pain syndromes. It may be more effective if you also have chronic pain caused by nerve problems such as shingles or diabetic neuropathy. It may help relieve sleeping problems and fatigue caused by chronic pain. This medicine is often used in lower doses when it is used to treat chronic pain than when it is used to treat depression. Elderly people and adolescents may react strongly to amitriptyline, and may therefore need smaller doses. In fact, amitriptyline is often avoided in people over 60. This medicine can make your skin more sensitive to the sun. Use sunscreen with an SPF that your doctor recommends. Baclofen- is in a class of medications known as “muscle relaxants”. The goal of muscle relaxants is to normalize muscle excitability, decrease pain, and improve motor function. They exert their pharmacologic effect centrally at the level of the spinal cord, the brainstem, or the cerebrum. Baclofen is a GABA agonist, and its primary action is at the spinal cord. It improves muscle contraction and joint range of motion resulting in improved mobility and functioning. Capsaicin- Capsaicin is the ingredient found in different types of hot peppers, such as cayenne peppers, that makes the peppers spicy hot. When a capsaicin lotion is used on the skin (topical use), capsaicin helps relieve pain. Capsaicin works by first stimulating and then decreasing the intensity of pain signals in the body. Although pain may at first increase, it usually decreases after the first use. Capsaicin stimulates the release of a compound believed to be involved in communicating pain between the nerves in the spinal cord and other parts of the body. You will likely experience a warm, burning, stinging sensation when you begin using capsaicin. The sensation, which is expected when beginning use, may actually continue for 2 to 4 weeks. The sensation should lessen the longer you use capsaicin. Reducing the number of daily doses of capsaicin will not reduce the sensation, but it may reduce the pain relief achieved Be aware of what can happen if you get capsaicin in your eyes or on other sensitive body parts because of the burning sensation it causes. If capsaicin gets in your eyes, immediately flush your eyes with water. To rid other sensitive areas of capsaicin and the burning feeling, wash the areas with warm soapy water. Keep capsaicin out of reach of children. Also, be aware that capsaicin should not be used by children under 2 years of age. Carbamazepine - is effective for relieving chronic pain caused by damage to nerves, either from injury or disease, although the data available to support this is limited. Anticonvulsants (also known as antiepileptics) are a group of medicines commonly used for treating 'fits' or epilepsy, but which are also effective for treating pain. The type of pain which responds well is neuropathic pain, e.g., postherpetic neuralgia (persistent pain experienced in an area previously affected by shingles), trigeminal neuralgia, and painful complications of diabetes. About two-thirds of patients who take carbamazepine for neuropathic pain can expect to achieve good pain relief in the short term. Clonidine- is an alpha-2 agonist and antihypertensive agent that has been studied extensively in the area of pain management. Although Clonidine’s mode of action in pain management is not fully understood it is believed to play a key part in the descending modulation of pain which results in widespread analgesia. Cyclobenzaprine- is in a class of medications known as “muscle relaxants”. The goal of muscle relaxants is to normalize muscle excitability, decrease pain, and improve motor function. They exert their pharmacologic effect centrally at the level of the spinal cord, the brainstem, or the cerebrum. Cyclobenzaprine produces its effects within the CNS (central nervous system), primarily at the brainstem level. Diclofenac- is in a class of medications known as NSAIDS. NSAIDS work on a chemical level. They block the effect of specific enzymes known as COX-1 and COX-2. These enzymes play a key role in making prostaglandins. By blocking the COX enzymes, NSAIDS stop the body from making prostaglandins and this results in a decrease in pain and swelling. Gabapentin- is often used to treat a type of pain called neuropathic pain. This type of pain involves nerves and can be intensely painful. Gabapentin can help to reduce pain levels since it blocks the transmission of nerve signals to the brain. Gabapentin may help with burning, stabbing pains, feelings of electric shock and other pain as it alters the way the body senses pain. Guaifenesin- is an over-the-counter expectorant that also has analgesic and skeletal muscle relaxant properties. Although guaifenesin’s mode of action in pain management is not fully understood it is believed to work by depressing transmission of nerve impulses in the central nervous system (CNS). Imipramine- is an anti-depressant medication that is also used as an analgesic for chronic and neuropathic pain, including post-herpatic neuralgia, diabetic peripheral neuropathy and headache syndromes. Tri-cyclic antidepressants such as imipramine are the most effective type of antidepressant used for pain. The pain killing mechanism of these drugs is still not fully understood. Antidepressants may increase neurotransmitters in the spinal cord that reduce pain signals. But they don't work immediately. You may feel some relief from an antidepressant after a week or so, but maximum relief may take several weeks. Ketamine- falls under the therapeutic category of general anesthetics. Ketamine is a drug that blocks a cascade of intracellular events that inhibit the hyper excitability of spinal cord neurons. Administration of ketamine is reported to reduce pain in patients with neuropathic pain of various origins, including post-herpatic neuralgia, complex regional pain syndrome, cancer pain, orofacial pain, and phantom limb pain. The topical form of ketamine has shown to be effective in treating painful neuropathy when other traditional methods have failed. Ketoprofen- is in a class of medications known as NSAIDS. NSAIDS work on a chemical level.They block the effect of specific enzymes known as COX-1 and COX-2.These enzymes play a key role in making prostaglandins. By blocking the COX enzymes, NSAIDS stop the body from making prostaglandins and this results in a decrease in pain and swelling. Lidocaine- is a local anesthetic medication used to treat acute and chronic pain. Lidocaine works by blocking the initiation and conduction of nerve impulses.The most common side effect when using lidocaine transdermally is numbness and tingling at the site of application. Nifedipine- is an antihypertensive agent. It is a type of medication known as a calcium channel blocker and it helps decrease blood pressure by encouraging vasodilation. Vasodilator agents can lead to substantial improvements in neuronal blood flow with corresponding improvements in nerve conduction which can help with diabetic neuropathy. Although Nifedipine’s mode of action in pain management remains unclear, it is believed that its ability to inhibit calcium influx plays an important role in pain processing. Orphenadrine- is in a class of medications known as “muscle relaxants”. The goal of muscle relaxants is to normalize muscle excitability, decrease pain, and improve motor function. Orphenadrine acts in the central nervous system to produce its effects. Muscle tightening or spasms result largely from signals in the nervous system telling the muscles to tighten or contract. Orphenadrine helps to relieve muscle tightening and stiffness by reducing the strength of those signals in the nervous system. Pentoxifylline- Although Pentoxifylline’s mode of action in pain management is not fully understood it is believed to work by inhibiting the production of pro-inflammatory cell signaling molecules. It also offers a new approach to therapy, reducing the blood viscosity and improving blood flow to small vessels in the vasculature which are embedded within organs and are responsible for the distribution of blood and nutrients within the tissue. Prilocaine- is a local anesthetic medication used to treat acute and chronic pain. Prilocaine works by blocking the initiation and conduction of nerve impulses.The most common side effect when using Prilocaine transdermally is numbness and tingling at the site of application. Tramadol- is used to relieve moderate to moderately severe pain. Tramadol binds to receptors in the CNS causing inhibition of ascending pain pathways, altering the perception of pain; also inhibits the reuptake of norepinephrine and serotonin, which also modifies the ascending pain pathway. Verapamil- is in a class of medications called calcium channel blockers and is usually used to treat high blood pressure and to control angina (chest pain). Calcium channel blockers are sometimes used to treat chronic pain for patients who do not respond to standard pain-relieving medications. Although the exact mechanism of action is not completely understood, it is believed calcium channel blockers work by blocking pain signals from the nerves to the brain. Side effects may include but are not limited to: Nausea Drowsiness Headaches Upset stomach Redness or itching at site of application Before having any laboratory test, tell your doctor and the laboratory personnel that you are using this pain medication. Stop using this medication and call your doctor if your symptoms get worse or you develop new or unexpected symptoms. In case of ingestion, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.