Background & Aims

Pain is being used as a tool to determine a new pathology or injury, treatment of the disease does not always result to resolution of pain.
Acute pain is sudden or urgent pain. Chronic pain is described as pain lasting for more than 3 months and is a common complaint among the adult population. Approximately 20% of the population do experience chronic pain causing limitation of activities of daily living. This results to patients seeking for the best treatment strategy available.
Ambroxol cream is an old medication that is being studied for repurposing as pain medication. Several cases have shown Ambroxol 20% cream as an effective analagesic.
Our objective is to present 23 cases of patients with acute pain or chronic pain of either somatic, neuropathic and nociplastic in origin. And the use of Ambroxol Cream with lesser concentration of 10% as an adjunctive analgesic on patients presenting both with acute and chronic pain of different etiology.

Methods

The authors of the study collected subjects from the pain management center of St. Lukes Medical Center, Quezon City by convenient sampling. Patients presenting with either somatic, neuropathic or nociplastic pain were recruited. There is no control group.

All patients recruited in a span of a month, totaled to 23 patients. Each patient signed a consent form prior to participating to the study.

All patients were assessed according to their pain profile. This was followed by the application of the Ambroxol Cream 10% on the painful area. Effectivity of the cream was assessed by recoding the time of onset of the medication as described by decrease in pain, time of maximum effectivity and time until the pain returned.

The cream was applied 3x a day for a span of 1-2 weeks according to the recurrence of pain.

Patients were also monitored on a daily basis via teleconsult and pain scale are recorded, tabulated and subsequently interpreted.

Results

All 23 patients presented with pain characterize as either aching, electric like, tearing, crushing and throbbing in character. All of them showed immediate decrease in pain within 5 to 10 minutes from the time the cream (10% Ambroxol) was applied. Together with the decrease in pain, patient’s also reported a cooling sensation immediately and up to 3 minutes from the time of application. Among the 23 patients, 19 presented with chronic pain of either somatic, neuropathic or nociplastic in origin while 2 patients had acute type of pain. 15 out of 23 patients are also taking co-analgesics prior to the application of the cream. Maximum pain relief was noted at 120 minutes. Efficacy lasted a duration of 240-600 minutes on majority of the patients. 1 patient reported that the efficacy lasted for 1320 minutes and another patient reported complete relief with no recurrence of pain. No adverse effects were noted during the short period of time, the cream was used.

Conclusions

In conclusion, a lower concentration Ambroxol 10% cream shows to be effective as a co-analgesic for Somatic, Neuropathic and Nociplastic types of Pain. It has promising result on both acute and chronic pain in origin. Its use provide not just relief but also improvement of overall patient function. This case series however did not show any long term side effects as the case series lasted for 7-14 days only, hence we recommend further studies on continuous application of the cream on the same group of patients.

References

1.Centers for Disease Control and Prevention. (2023, April 13). Chronic pain among adults – United States, 2019–2021. Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/72/wr/mm7215a1.htm
2.Definitions of chronic pain syndromes. International Association for the Study of Pain (IASP). (2022, December 15). https://www.iasp-pain.org/advocacy/definitions-of-chronic-pain-syndromes/
3.Kantar, A., Klimek, L., Cazan, D., Sperl, A., Sent, U., & Mesquita, M. (2020). An overview of efficacy and safety of ambroxol for the treatment of acute and chronic respiratory diseases with a special regard to children. Multidisciplinary Respiratory Medicine, 15(1). https://doi.org/10.4081/mrm.2020.511
4. Kern, K.-U., Schwickert-Nieswandt, M., Maihöfner, C., & Gaul, C. (2019). Topical Ambroxol 20% for the Treatment of Classical Trigeminal Neuralgia – A New Option? Initial Clinical Case Observations. Headache: The Journal of Head and Face Pain, 59(3), 418–429. https://doi.org/10.1111/head.13475
5.Maihöfner, C., Schneider, S., Bialas, P., Gockel, H., Beer, K., Bartels, M., & Kern, K. (2018). Successful treatment of complex regional pain syndrome with topical ambroxol: a case series. Pain Management, 8(6), 427–436. https://doi.org/10.2217/pmt-2018-0048
6.Kern, K., & Weiser, T. (2015). Topical ambroxol for the treatment of neuropathic pain. Der Schmerz, 29(S3), 89–96. https://doi.org/10.1007/s00482-015-0060-y
7.Cazan D, Klimek L, et. al. Safety of ambroxol in the treatment of airway diseases in adult patients. Expert Opin Drug Saf. 2018 Dec;17(12):1211-1224. doi: 10.1080/14740338.2018.1533954. Epub 2018 Nov 22. PMID: 30372367
8.Weiser T. Comparison of the effects of four Na+ channel analgesics on TTX-resistant Na+ currents in rat sensory neurons and recombinant Nav1.2 channels. Neurosci. Lett. 395(3), 179–184 (2006)
9.Wang J, Ou SW, et. al. Distribution and function of voltage- gated sodium channels in the nervous system. Channels (Austin). 2017;11(6):534-554. doi:10.1080/19336950.2017.1380758
10.Zhao P, Barr TP. Et. al. Voltage-gated sodium channel expression in rat and human epidermal keratinocytes: evidence for a role in pain. Pain 139(1), 90–105 (2008)
11.Akopian AN, Sivilotti L, et. al. A tetrodotoxin-resistant voltage-gated sodium channel expressed by sensory neurons. Nature. 1996;379:257-262.
12.Gaida W, Klinder K, Arndt K, et. al. Ambroxol, a Nav1.8- preferring Na+ channel blocker, effectively suppresses pain symptoms in animal models of chronic, neuropathic and inflammatory pain. Neuropharmacology. 2005;49:1220-122
13.Russo, M. A., Baron, R., Dickenson, A. H., Kern, K.-U., & Santarelli, D. M. (2022). Ambroxol for neuropathic pain: Hiding in plain sight? Pain, 164(1), 3–13. https://doi.org/10.1097/j.pain.0000000000002693
14.Anaesthesia, D. of. (n.d.). Redefining the role of analgesic adjuvants in pain…?: Indian Journal of pain. LWW. https://journals.lww.com/ijpn/fulltext/2023/37020/redefining_the_role_of_analgesic_adjuvants_in_pain.2.aspx
15.Chou, R., Wagner, J., Ahmed, A. Y., Blazina, I., Brodt, E., Buckley, D. I., Cheney, T. P., Choo, E., Dana, T., Gordon, D., Khandelwal, S., Kantner, S., McDonagh, M. S., Sedgley, C., & Skelly, A. C. (2020, December 1). Introduction. Www.ncbi.nlm.nih.gov; Agency for Healthcare Research and Quality (US). https://www.ncbi.nlm.nih.gov/books/NBK566500/#:~:text=Acute%20pain%20has%20been%20defined
16. Bonezzi, C., Fornasari, D., Cricelli, C., Magni, A., & Ventriglia, G. (2020). Not All Pain is Created Equal: Basic Definitions and Diagnostic Work-Up. Pain and Therapy, 9(S1), 1–15. https://doi.org/10.1007/s40122-020-00217-w
17.Nguyen, T. N. M., Laetsch, D. C., Chen, L.-J., Haefeli, W. E., Meid, A. D., Brenner, H., & Schöttker, B. (2020). Pain severity and analgesics use in the community-dwelling older population: a drug utilization study from Germany. European Journal of Clinical Pharmacology, 76(12), 1695–1707. https://doi.org/10.1007/s00228-020-02954-5

Presenting Author

Rosalee E. Gonzales

Poster Authors

Rosalee Gonzales

MD

St. Luke's Medical Center Quezon City

Lead Author

Topics

  • Treatment/Management: Pharmacology: Non-opioid