We work together with doctors and their patients to solve problems using customized medications.
Pain Management
We offer patients a multidisciplinary approach and customized treatment protocols to meet your needs.
Topical and Transdermal
Medications can be compounded into creams, gels, and other various routes of administration.
Custom Pain Management
Our specially trained compounding pharmacists are able to work with you to create customized medication solutions.
Pain management is essential because, even when the underlying disease process is stable, uncontrolled pain prevents patients from working productively, enjoying recreation, or taking pleasure in their usual roles in the family and society. Chronic pain may have a myriad of causes and perpetuating factors, and therefore can be much more difficult to manage than acute pain, requiring a multidisciplinary approach and customized treatment protocols to meet the specific needs of each patient.
Optimal treatment may involve the use of medications that possess pain-relieving properties, including some antidepressants, anticonvulsants, antiarrhythmics, anesthetics, antiviral agents, and NMDA (N-methyl-D-aspartate) antagonists. NMDA-receptor antagonists, such as dextromethorphan and ketamine, can block pain transmission in dorsal horn spinal neurons, reduce nociception, and decrease tolerance to and the need for opioid analgesics. [Anesth Analg 2001 Mar;92(3):739-44] By combining various agents which utilize different mechanisms to alter the sensation of pain, physicians have found that smaller concentrations of each medication can be used.
Topical and transdermal creams and gels can be formulated to provide high local concentrations at the site of application (e.g., NSAIDs for joint pain), for trigger point application (e.g., combinations of medications for neuropathic pain), or in a base that will allow systemic absorption. Side effects associated with oral administration can often be avoided when medications are used topically. Studies suggest that there are no great restrictions on the type of drug that can be incorporated into a properly compounded transdermal gel. When medications are administered transdermally, they are not absorbed through the gastrointestinal system and do not undergo first-pass hepatic metabolism.
We work together with prescriber and patient to solve problems by customizing medications that meet the specific needs of each individual. Please contact our compounding pharmacist to discuss the dosage form, strength, and medication or combination that is most appropriate for your patient.
Steven’s Pain Management Compounds
The following list is just a few of the preparations that we can compound for pain and pain management.
Neuropathic Pain
The following article discusses the use of topical ketamine 0.5% (5 mg/ml) gel, applied as a thin film two to three times daily over the skin where pain was severe. Topical ketamine reduced pain for patients with postherpetic neuralgia with no systemic side effects.
Neurology. 2003 Apr 22;60(8):1391-2.. Topical ketamine treatment of postherpetic neuralgia..
The following randomized, double-blind, placebo-controlled study assessed the analgesic efficacy of topical administration of 3.3% doxepin hydrochloride, 0.025% capsaicin or a combination applied daily for 4 weeks in 200 adult patients with chronic neuropathic pain, and reported that all three preparations significantly reduced overall pain.
Br J Clin Pharmacol. 2000 Jun;49(6):574-9.. Topical application of doxepin hydrochloride, capsaicin and a combination of both produces analgesia in chronic human neuropathic pain: a randomized, double-blind, placebo-controlled study..
Migraine
The following article concludes: A fixed combination of indomethacin 25 mg, prochlorperazine dimaleate 4 mg, and caffeine 75 mg is significantly more effective than sumatriptan in the acute treatment of migraine attacks versus sumatriptan 25 mg, both rectal suppositories.
Headache. 2003 Sep;43(8):835-44.. Efficacy of a fixed combination of indomethacin, prochlorperazine, and caffeine versus sumatriptan in acute treatment of multiple migraine attacks: a multicenter, randomized, crossover trial..
The following article concludes: Oral therapy with a combination of LAS (equivalent to 900 mg ASA) and metoclopramide 10 mg was superior to placebo with therapeutic gains of 30% and 31% for the first treated attack, and was comparable to 100 mg sumatriptan.
Funct Neurol. 2000;15 Suppl 3:196-201.. The effectiveness of combined oral lysine acetylsalicylate and metoclopramide (Migpriv) in the treatment of migraine attacks. Comparison with placebo and oral sumatriptan..
NSAID Therapy
To avoid the risks of COX-2 inhibitors, our pharmacy can compound topically applied NSAIDs such as ibuprofen and ketoprofen. Topical NSAIDs have a safety profile which is superior to oral formulations. Topical NSAID administration offers the advantage of local, enhanced delivery to painful sites with a reduced incidence of systemic adverse effects.
Topical preparations can be customized to contain a combination of medications to meet the specific needs of each patient.
QJM. 1995 Aug;88(8):551-7.. Non-steroidal anti-inflammatory drugs and hospitalization for acute renal failure..
BMJ. 1998 Jan 31;316(7128):333-8.. Quantitative systematic review of topically applied non-steroidal anti-inflammatory drugs..
Phys Ther. 2006 Mar;86(3):424-33.. Ketoprofen gel as an adjunct to physical therapist management of a child with Sever disease..
Topical Anesthetics
The following article concludes: “LAT gel (4% lidocaine, 1:2000 adrenaline, 0.5% tetracaine) worked as well as TAC gel (0.5% tetracaine, 1:2000 adrenaline, 11.8% cocaine) for topical anesthesia in facial and scalp lacerations. Considering the advantages of a noncontrolled substance and less expense, LAT gel appears to be better suited than TAC gel for topical anesthesia in laceration repair in children.”
Pediatrics. 1995 Feb;95(2):255-8.. Lidocaine adrenaline tetracaine gel versus tetracaine adrenaline cocaine gel for topical anesthesia in linear scalp and facial lacerations in children aged 5 to 17 years..
Topical Opioids
The use of topical morphine gel is reported in two children with epidermolysis bullosa, where acute inflammatory pain is a major symptom and where effective analgesia is a major clinical problem.
Arch Dis Child. 2004 Jul;89(7):679-81.. Peripheral opioids in inflammatory pain..
Morphine sulfate 10 mg in Intrasite gel was applied topically to skin ulcers of hospice inpatients. The topical morphine was not absorbed in the majority of patients, suggesting any analgesic effect was mediated locally rather than systemically.
J Pain Symptom Manage. 2004 May;27(5):434-9.. The bioavailability of morphine applied topically to cutaneous ulcers..
Example of Compounded Medications
All formulations are customized per prescription to meet the unique needs of each patient. Please call us to discuss the dosage form, medication, and strength which are most appropriate for your patient.
- Ketoprofen topical or transdermal gel
- Ketamine transdermal gel
- Ketamine/Ketoprofen/Gabapentin transdermal gel
- Lidocaine/Prilocaine topical gel
- Triple-Anesthetic gel – benzocaine/lidocaine/tetracaine (“BLT”)
- Gabapentin/Clonidine in PLO (Pluronic Lecithin Organogel)
- Piroxicam tablet triturates
- Ibuprofen suppositories
- Ketoprofen/Cyclobenzaprine topical gel
