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Electrolysis Pain : What to
expect; factors involved in the perception of pain. |
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Pain Control : A
preferred method to alleviate/eliminate the discomfort of electrolysis
treatment. |
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Oral Nonopioid
Medications : Oral pain medication used in addition to topical pain
management. |
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Adjunct Medical
Support : Physician facilitated pain management during electrolysis treatment. |
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EMLA : A topical
anesthetic. |
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Occlusive Dressings
: Application instructions for cream type topical anesthetics like EMLA. |
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OTC topical analgesics
: Non-prescription topical analgesics available to the electrology
patient. |
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Pain
Control
The
discomfort of electrolysis pain that continues during the extended
electrolysis session is not only an unpleasant sensation but an
emotionally taxing experience.
A variety
of techniques that involve cosmetic procedures such as permanent hair
removal, the coagulation of soft tissue, and skin resurfacing in the
specialties that include electrology, dermatology, and plastic surgery,
can only be adequately performed after the highly sensitive nerve
endings in the skin are anesthetized. Effective transdermal
(percutaneous) administration of anesthetic is the preferred method due
to its low risk factors and minimal intrusion. Adjunct relief can be
accomplished with oral medication in the form of nonopioid
analgesics, either of a prescription type or an over-the-counter
analog.
Transdermal
anesthetics are widely used in dental applications such as the
application of an anesthetic to the gum prior to injecting anesthetic.
But mucous membranes, such as the lining of the mouth, allow topical
anesthetics to be readily absorbed and perform well. However, the skin
possesses mechanics and physiology of absorption are that are quite
different. The skin provides a remarkable barrier and is highly
impermeable to the passage of pathogens, toxic materials and physiologic
fluids. Accordingly, the skin is highly resistant to the absorption of
analgesics.
The
skin's impermeability may be attributed to the thin layer of dense,
metabolically inactive cells approximately ten microns (10-15 cells)
thick, called the stratum corneum or cornified layer. As a result of the
high degree of keratinization of the cells which comprise the stratum
corneum, a formidable barrier is created. By comparison, the
effective absorption through mucosal surfaces, as previously cited, is
very effective since the stratum corneum is absent.
While
transdermal absorption depends on a variety of factors that include skin
hydration, body temperature, permeability of the drug delivery system,
and size of the active drug molecule, amongst others, its effective
delivery is considered preferable to the inherent risks of
routine anesthetic injection that are associated with ongoing
electrolysis treatment.
EMLA is a
relatively well utilized eutectic transdermal anesthetic that is
prescribed by physicians to electrology patients. It is aptly named for
the mixing of its anesthetic constituents, lidocaine and prilocaine,
creating a Eutectic Mixture of Local Anesthetics.
Eutectic refers to a mixture whose melting point is lower than that of
its constituent parts. In the case of EMLA, that eutectic mixture is
lidocaine and prilocaine in a ratio of 1:1 by weight (2.5% each). EMLA cream, however, is an oil-in-water emulsion whose
anesthetic effect is very weak, short lived, and requires in excess of
one hour of covered (occlusive dressing) application prior to the
procedure. For these reasons, it has limited use in medical
practice. An appropriate situation for its use, as an example, may
be with the pediatric patient. By applying EMLA and numbing an
area prior to venipuncture, such as blood drawing, a young patient may
be relieved from some of the trauma of the situation. But extensive
procedures are much more physically traumatic than a needle stick, and
EMLA provides little benefit.
In such
cases as extensive electrolysis (i.e., beard removal), EMLA cream and
similarly rated topical anesthetics are not sufficient. The method
of choice for laser resurfacing, transdermal anesthetic application, is
also an excellent choice for electrolysis; the drug is still a eutectic
mixture, but increased to approximately a factor of six in anesthetic
compared to EMLA. A vasoconstrictor is also added to localize the
effect, so the anesthetic will not be so quickly metabolized away.
Lidocaine
is a highly effective anesthetic. The local anesthetic action of
lidocaine occurs by stabilizing the neuronal membrane as it inhibits the
ionic fluxes required for the initiation and conduction of impulses.
However, it is not effectively absorbed through the skin. But, the
lowered melting point by way of a eutectic mixture is not the only
enhancement that allows for effective passage through the skin. The base
must be hydrophobic. Unfortunately, EMLA cream is comprised of more than
90 percent water. To create an effective transdermal preparation, an
ointment base is essential. An example of an ointment base is
petrolatum. As compared to EMLA, such a product would be comprised of
less than one percent water. For ease of use in referring to these high
potency topical eutectic-type anesthetics that are custom formulated for
our (TGIP) patients, we have named the drug Epil-EZ.
In
clinical use, electrology patients report little or no treatment
discomfort with the use of Epil-EZ anesthetic. The skin requires the
usual preparation by cleansing with an alcohol pad, followed by a thin
layer of anesthetic. Within a few minutes, the area is
sufficiently numbed to begin treatment. From one application, the
area remains desensitized on an average of about 3 hours, with some
patients experiencing a return of sensation in as little as 90 minutes,
and others, as long as 6 hours. Subsequent application of Epil-EZ
will quickly regain the anesthetic effect. Additionally,
vasoconstriction and the anesthetic effect tend to reduce swelling and
inflammation during and after the process. Under normal conditions, the
limiting factor to extensive treatment is not discomfort but the amount
of electrolysis that can be administered within a given area.
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