UMEM Educational Pearls

Title: Topical treatment of lower back pain in the ED

Category: Orthopedics

Posted: 3/8/2025 by Brian Corwell, MD (Updated: 3/31/2025)
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Lidocaine transdermal patches

Frequently used for lower back pain.

A single 5% patch contains 700mg of lidocaine.

There is low systemic absorption.

Data supporting efficacy for lower back pain are limited.

Best benefit in other neuropathic conditions such as post herpetic neuralgia.

Topical capsicum

Underused, safe, non-sedating.

Potential treatment option for acute and subacute back pain (<3 months duration).

Can be OTC or via prescription.

Available in cream, lotion and patches.

Best used 3-4 times per day for maximal effectiveness.

Grade A recommendation from North American Spine Society.