Compounding medications was part of the pharmacist’s daily routine before manufacturing companies began the mass production of prescriptions drugs. Pharmacists compounded, or specially blended, almost all prescriptions until the mid twentieth century when large pharmaceutical companies began dispensing medications. Today, pharmaceutical compounding is growing in popularity as physicians search for treatment alternatives for their patients who do not respond well to the typical “one size fits all” therapies.
Treatment of acute and chronic pain is not easy. Patients often suffer from various ailments such as arthritis, tendinitis, diabetes, back injury and headaches. Often the medicines prescribed to treat these conditions may be successful in reducing or alleviating the pain, but can leave the patient with intolerable side effects resulting in the inability or unwillingness to continue the treatment. For example, the dry mouth associated with certain drugs can be remedied in a compounded lollipop that increases salivation, therefore avoiding the annoying side effect. For others, the medicine may be working, but not well enough and additional treatment is needed. At National Center for Pain Management and Research Custom Pharmacy, the pharmacists specialize in compounding topical pain creams that allow the patient to apply medications directly to the site of pain. Topical and transdermal creams and gels can be formulated to provide high drug concentrations at the site of application (e.g., NSAIDs for joint pain). By applying the medications locally instead of taking a pill, the gastrointestinal tract and the bloodstream are bypassed and harmful side effects can be avoided. Furthermore, topical pain creams can be used in conjunction with oral pain medication bringing greater comfort to patients who are currently experiencing limited relief from pain. For patients who suffer vaginal, rectal, or hemorrhoidal pain, suppositories or rectal rockets containing pain medications can be compounded to ease the pain.
National Center for Pain Management and Research’s compounding pharmacists can customize treatments for each individual by creating different combinations and strengths of medications based on the physician’s orders. These customized medications usually contain more than one active ingredient and are truly “what the doctor ordered.” Our pharmacists can also tailor the base to which the active ingredients are added. Some patients prefer a thick, cream-like base while others prefer a thin, lotion-like consistency. Patients who have sensitive skin may need a formula prepared for their specific needs. Bases can also be changed to increase or decrease absorption. Compounding pharmacists will work with the patient and the physician to specialize each prescription to meet the unique needs of the patient, especially in the field of pain management. There has never been so many options for the topical treatment of pain as there are today.
Compounded pain creams can contain combinations of any of the following medications:
- Muscle relaxants
- Pain blockers
- Neuropathic agents
NSAIDS, such as, ibuprofen, are used to reduce pain and inflammation. They work by blocking enzymes that increase your pain. By using these drugs topically, we can avoid many of the serious side effects that can happen when NSAIDS are taken orally. Muscle relaxants, such as baclofen or cyclobenzaprine, relax the muscle and decrease muscle spasms by interfering with neurotransmitters that cause muscle tightness. Pain blockers work by blocking pain receptors, and examples are ketamine and amantadine. Neuropathic agents, such as gabapentin and amitriptyline, interfere with nerves that transmit neuropathic pain. Topical application of these medications helps avoid systemic side effects and allow treatment directly at the site of pain. Additionally, anesthetics numb the area of application increasing pain relief. Examples of anesthetics are lidocaine, tetracaine, and bupivacaine. Prescribing physicians determine which combination of medications will work best for the patient. If the first formula does not work as well as expected, the pharmacist, physician, and patient can work together to create a new combination that better satisfies the needs of the patient. Topical treatment of pain can work for almost everyone. It is a matter of finding the right combination and strength of drug that works best for the patient. Our pharmacy has seen great success in the treatment of pain with topical compounded medications. We believe they are a crucial part of the multi-modal treatment of pain.