The American Academy of Pain Medicine and the American Pain Society have reported that 80% of doctor visits are related to pain.  Pain is our body's way of warning us of possible or actual harm, which is triggered by the nervous system.  Pain can be a helpful way of telling us when something is not right, however, when pain is chronic or severe, it is especially important to treat it and get it under control.

Managing pain can be a challenge and frustrating experience. Many pain medications when given orally  to provide the pain relief sought can have debilitating side effects. These side effects may include drowsiness, dependency, and may adversely affect other organs when taken over a long period of time. Sometimes the type of pain experienced just doesn't respond well to this traditional therapy. 

Neuropathic pain is due to dysfunction of the nervous system which can lead to pain that is excessive, as well as burning and tingling and it can be especially difficult to treat. This is where a compounding pharmacist can help. Many oral pain medications can actually be applied topically, right where it hurts or can be compounded as a rectal rocket a suppository type vehicle for relief of pain.

The right drug at the right dose administered to the right patient may afford tremendous functional improvement for a patient with pain.

Topical and transdermal medications are one of many drug delivery solutions to consider.

Topical administration of medications is a highly effective add on treatment to traditional pain regimens.  Topical delivery acts locally, directly at the site of the pain.  Transdermal medications are absorbed through the skin and work throughout the body.

This method of drug delivery can work well, if you experience the following:

• Muscle pain from injury or soreness/tightness
• Nerve pain from injury or painful conditions such as post-shingles pain
• Joint pain such as that from arthritis or sprains
• Bone pain
• if you are a under hospice care
• Diabetic neuropathic pain

Some advantages of topical and transdermal pain medications are:

• Decreased risk of interactions with other medications
• Medication working directly at the site of pain/injury
• Fewer side effects

Many compounded drug combinations for pain treatment exist.  They may involve several drugs with different ways of working, or a single drug which works several ways.  Each compound offers clear benefits.  Decisions on which to use can be tailored to specific patient needs.  Some examples include NSAIDs (non-steroidal anti-inflammatory drugs) such as ketoprofen which decrease inflammation that is linked to pain response.  Several topical NSAIDs are currently manufactured by major drug companies, others can be individually compounded for pain relief.  Opioids such as methadone are commonly used orally to treat severe pain, however they are associated with negative side effects such as dizziness, dry mouth, fatigue and tolerance.  Topical opioids effectively treat pain symptoms with minimal side effects and tolerance.  Some other medications often used topically to treat pain include neuroleptics such as gabapentin and anesthetics such as tetracaine.  Case studies have shown all of these to be highly effective pain treatments.

 At Rock Ridge Pharmacy, our goal is to provide each individual with the best care possible.  We have been dispensing topical and transdermal pain treatments with much success.  Ask your doctor about using transdermal or topical compounded pain therapy.

Case Study: Methadone/Tetracaine

Patient RH, a 91-year-old woman, was admitted to hospice with a diagnosis of debilitiy. Cardiovascular disease, pulmonary disease, and type 2 diabetes have contributed to her decline. The patient has bilateral peripheral neuropathies in her legs due to her diabetes. At admission, she was not on any medication to treat the neuropathy. The hospice practitioner prescribed PLO methadone/tetracaine 0.5/5%, applied 2 to 3 mL to each leg twice daily. Several days later, the patient reported her pain level had declined from a 7 of 10 to a 0 of 10, and that she routinely gets about 15 hours of pain relief after application of the PLO.

Vadaurri, RPh, BCPS, Vince. "Topical Treatment of Neuropathic Pain." International Journal of Pharmaceutical Compounding 12 (2008): 182-190.

Case: Gabapentin

Patient LM, a 79-year-old white woman was admitted to hospice with a diagnosis of pulmonary hypertension. On admission, one of the patient’s primary problems was, “My right lower leg is my trouble spot”. The practitioner recorded the pain as “severe, shooting pain across the anterior lower leg that is very bothersome.” To control the pain, the patient had been treated with nortriptyline 25mg at bedtime and hydrocodone/acetaminophen 5/500mg as needed. The patient continued on oral medications but the pain remained; the practitioner added PLO gabapentin 5% to be applied 2mL twice daily to the patient’s lower leg. The next day, the patient reported that, following treatment with the PLO gabapentin, her leg pain had decreased from a level of 8 of 10 do 2 to 3 of 10.

Vadaurri, RPh, BCPS, Vince. "Topical Treatment of Neuropathic Pain." International Journal of Pharmaceutical Compounding 12 (2008): 182-190.