This study had a number of methodologic limitations that make the findings difficult to interpret. The authors did not assess overall markers of health, including health care utilization and/or medication utilization in the year prior to and during the index pregnancy, which might make the observed associations incorrect. No information was provided on the acetaminophen strength and number of dosage units taken; therefore, no conclusions can be made regarding a dose-response relationship. The authors also did not assess clinical ADHD diagnoses. Findings from two other observational studies of neurodevelopment in children exposed to acetaminophen during gestation are conflicting; however, neither of these studies specifically assessed ADHD as an outcome. 14, 15
Topical analgesia is generally recommended to avoid systemic side-effects. Painful joints, for example, may be treated with an ibuprofen - or diclofenac -containing gel (The labeling for topical diclofenac has been updated to warn about drug-induced hepatotoxicity.  ); capsaicin also is used topically . Lidocaine , an anesthetic , and steroids may be injected into painful joints for longer-term pain relief. Lidocaine is also used for painful mouth sores and to numb areas for dental work and minor medical procedures. In February 2007 the FDA notified consumers and healthcare professionals of the potential hazards of topical anesthetics entering the blood stream when applied in large doses to the skin without medical supervision. These topical anesthetics contain anesthetic drugs such as lidocaine, tetracaine, benzocaine, and prilocaine in a cream, ointment, or gel.