EMLA paste
Dose. adhesive (Eutectic Mixture of Local Anesthetics) 5% emulsion preparation, containing 2.5% each of lidocaine/prilocaine, or compounding pharmacist can put it in orabase.
Ketoprofen
Dose. 20% strength in PLO vehicle, 30 grams. Apply a small (pea size) amount of cream over the painful TMJ. Rub it in until it is fully absorbed through the skin, can be repeated 4X/day.
Labs/Monitor. Discontinue if symptoms fade.
Comments. Osteoarthritis of TMJ, good if pt can not have meds b/c of GERD.
Lidocaine.
Dose. 4% strength in PLO vehicle and 20% in lipoderm vehicle .Apply a small (pea size) amount of cream over the painful TMJ. Rub it in until it is fully absorbed through the skin, can be repeated 4X/day
Labs/Monitor. If symptoms fade discontinue.
Voltaren gel /diclofenac 2%
Dose. Apply a small (pea size) amount of cream over the painful TMJ. Rub it in until it is fully absorbed through the skin, can be repeated 4X/day.
Labs/Monitor. If symptoms fade discontinue.
Benzocaine.
Dose. 20% strength in orobase PASTE not gel vehicle. Apply a small (pea size) amount of cream over the painful TMJ. Rub it in until it is fully absorbed through the skin, can be repeated 4X/day.
Labs/Monitor. Wash hands immediately after use.
Comments. Colgate makes a commercial OTC.
Topical meds you need to remember:
• Lidocaine 4% or Benzocaine 20%
• Capsaicin 0.025 to 0.075%,
• Ketamine, from 0.5 to 5%,
• Clonidine 0.01 to 0.4% (Catapress 2.5mg, change every week).
• CBZ 2-4%,
• Gabapentin 6%,
• NSAIDs 10% (diclofenac or ketoprofen).
Several pharmacies offer compounding services. The following two are examples:
Rancho Pharmacy - Compounding Services (myranchopharmacy.com)
Pain Management Therapy With Compounding Pharmacy Beverly Hills (compoundingexpert.com)
Padilla M, Clark G, Merrill R, "Topical Medications for Orofacial Neuropathic Pain: A Review", Journal of American Dental Association, Vol 131, Feb. 2000.