Topical preparations for pain relief: efficacy and patient adherence

Figures & data

Figure 1 Topical patch.

Figure 2 Opioid transdermal patch.

Figure 3 Iontophoretical transdermal system (ITS). ITS delivers drug into the bloodstream, and includes: anode hydrogel (ionized drug reservoir), cathode (inert ingredients), battery, and protective plastic liner.

Table 1 Brief description of different strategies to increase treatment adherence in selected diseases

✓ Patient awareness of breast cancer has increased, and physicians are required to provide information regarding treatment goals and adverse effects of drugs, which are frequent and disabling. These issues influence compliance.^Citation78 ✓ Among patients with cardiac failure, the main predictor for cardiac rehabilitation was the physician’s endorsement of the effectiveness of program. Adherence increased when patients were actively referred, educated, highly self-motivated, and when programs were easily accessible.^Citation79 ✓ The major barriers for a good glycemic control include low efficacy of oral hypoglycemic drugs, fear of hypoglycemia, issues related to convenience of treatment (subcutaneous route, invasive blood sugar monitoring), poor access to health services, and lifestyle, leading to low adherence.^Citation80 ✓ Educational sessions, psychotherapeutic interventions, and phone prompts in community psychiatric services increase adherence of psychotic patients.^Citation81 ✓ Factors associated with poor treatment adherence among patients undergoing renal replacement therapy or under dialysis are frequent dosing, patient’s perception of treatment benefits, poor patient–physician communication, lack of motivation, low socioeconomic background. Strategies for compliance are not well established, but some are suggested: treatment regimen simplification, establishing a partnership with the patient, and education.^Citation82 ✓ The most striking barrier to medication adherence in multiple sclerosis is forgetfulness to take pills, coping with adverse effects, and perceived lack of efficacy. Validated strategies include good provider–patient relationship, continuous education, and reinforcement regarding the benefit of treatment.^Citation83 ✓ Nonadherence of chronic obstructive pulmonary disease in 40%–60% as opposed to asthmatic patients, who adhere to inhalers and rescue medication. Economic factors and health beliefs influence device selection.^Citation84 ✓ Long-term adherence for asymptomatic conditions such as arterial hypertension is 50%. For these patients, adverse effects related to antihypertensive therapies and costs threaten treatment adherence.^Citation85 The most commonly used method to increase in compliance in dyslipidemia^Citation86 and hypertension^Citation87 is dosing schedule modification from twice to once a day dosing.

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