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Pain Compounds

More than 86 million Americans suffer from pain. If you are one of these people suffering from acute or chronic pain, ask your healthcare provider how Family Pharmacy might be able help. Our specialized pharmacists will work closely with your physician to determine the origin, severity and regularity of the pain, so that a personalized treatment can be created for your specific needs. Compounded medications are applied topically directly to the affected area; the medication is then absorbed through the skin, delivering high concentrations of very effective medications to the direct exact location of the pain. This method may improve pain control, reduce side effects found in other drugs, decrease the need for oral medication and may result in fewer drug to drug interactions associated with systemic medications.

1.) Use the prescription exactly as prescribed by your healthcare provider. Read your prescription label carefully.

2.) Apply the custom compound cream to clean, dry skin that does not have any cuts, infections, or rashes.

3.) Select creams may feel tacky or sticky. This is normal.

4.) Gently massage the custom compound cream into your affected pain area for 1-2 minutes even if the cream disappears

5.) Do not skip you dose. The product works best when you follow the exact directions.

6.) Avoid exposing skin, where you apply custom compounding cream, to sunlight and artificial light, such as tanning beds.

7.) Do not get the Transdermal Pain CreamRx in your eyes, nose, mouth or any body parts that you have not been advised to apply the cream.

8.) If your product arrives warm, please store at room temperature for 12 hours before using.

9.) Store the Transdermal Pain CreamRx at room temperature (20-25 degree celsius or 68-77 degrees fahrenheit).

10.) If you experience any reactions, please call us immediately.

11.) Most custom compound cream(s) have a beyond use date (BUD) of 30 days and should be properly discarded after this time.

Why use Transdermal Pain Creams?

Many patients experience stomach irritation or other unpleasant side effects from taking pain medication; some have difficult taking medications in their commercially available form. Compounded medications may provide an alternative method for relieving pain for those who suffer. We specialize in custom compounded transdermal pain creams that absorb directly into the skin and are formulating based off each patients individual needs. Transdermal application allows for medications to bypass the gastrointestinal (GI) tract, providing optimal results with less GI irritation, and help patients who have difficulty swallowing pills.

FAQ

We use the highest quality and FDA approved ingredients when formulating our compounded medications. Our skillfully trained pharmacists will work directly with your healthcare provider to ensure the active ingredients selected for your custom compounded medication are most suitable for your specific needs. Due to the complex nature of pain, the use of multiple agents with complimentary modes of action is often key to the success of transdermal therapy. The ultimate goal is to pick the combination of ingredients that result in the best therapeutic outcome, by working closely with the patient, prescriber, and compounding pharmacist.

1.) Acyclovir – For patients with shingles or postherpetic pain, the addition of the antiviral drug acyclovir (in concentrations of 5%) can be very effective. Combine with gabapentin and ketamine for postherpetic pain.

2.) Amitriptyline – Amitriptyline is a tricyclic antidepressant agent. It is has been used extensively as an analgesic agent for management of neuropathic pain. Unfortunately, the higher oral doses needed to achieve an analgesic effect cause somnolence and dry mouth, thus limiting patient tolerance and compliance. Side effects are eliminated following topical administration. Amitriptyline is used topically in concentrations of 2-5%.

3.)Baclofen – Baclofen is a GABA β receptor agonist. GABA receptor agonists primarily cause muscle relaxation. Baclofen is commercially available as an oral tablet and an intrathecal injection. Baclofen helps reduce painful muscle spasms and clonus in patients with multiple sclerosis and other musculoskeletal conditions. Baclofen is used topically in concentrations of 1-2%. Baclofen is effective but expensive.

4.)Clonidine – Although the precise mechanism of action is unknown, it is believed that clonidine may decrease the site-specific local release of norepinephrine, an agent that stimulates sensitized nerve fibers to cause painful sensations. Clonidine is used orally to treat hypertension, but is also given by epidural or intrathecal injection to help control pain. It is not effective for pain when taken orally. Clonidine’s topical effects were discovered when some patients experienced pain relief following the application of the clonidine-TTS patch. Unfortunately, the effects were very localized, thus limiting the usefulness of the patch. However, the ability to apply clonidine directly to the pain site or dermatome is a significant advantage of our cream formulations. Clonidine is used topically in concentrations of 0.1 – 0.2%.

5.) Cyclobenzaprine – Cyclobenzaprine (trade name Flexeril® ) is structurally similar to the tricyclic antidepressants (such as amitriptyline). It is prescribed orally to relieve muscle pain and stiffness caused by injuries such as sprains or strains. When incorporated into creams it is reported to be very effective in relieving muscle tightness in patients with Fibromyalgia Syndrome (FMS) and multiple sclerosis. Cyclobenzaprine is used in a concentration of 1- 2%.

6.) Gabapentin – Gabapentin (trade name Neurontin® ) is an antiepileptic medication used to control seizures. There have long been recognized similarities with neuronal misfiring in epilepsy and neuropathic pain. Phenytoin, a commonly prescribed anticonvulsant medication, was shown to have analgesic effect in neuropathic pain in 1942. In neuropathic pain, injured nerve fibers may discharge spontaneously – usually at regular intervals – causing significant pain. Gabapentin is a glutamate antagonist. Glutamate is the chemical that stimulates the NMDA pain receptors (see ketamine section below). Blocking glutamate blocks pain transmission. When administered orally (dosage range of 2400-3600mg/day), Gabapentin has shown results in managing pain caused by diabetic neuropathy and postherpetic neuralgia. Topically, the concentrations used are around 5-6%. Gabapentin is very effective and is well tolerated. It should be considered as a mainstay ingredient for all neuropathic pain creams.

7.)Guaifenesin – Oral guaifenesin is used as an expectorant to decrease viscosity of respiratory secretions. Topically, guaifenesin is an effective skeletal muscle relaxant. Concentrations used are 5-10%.

8.)Ketamine – Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist and is topically used in concentrations of 6%. When the pain receptors in the dermatomes start sending signals there is a release of glutamate, which in turn acts on the NMDA receptors in the spinal cord. Activation of NMDA receptors causes the spinal cord neurons to become even more sensitive and responsive to painful stimuli. Ketamine works on receptors in the both the periphery and in the spinal cord. There is also new evidence that blocking NMDA receptors with drugs such as ketamine decreases the development of tolerance to opioids such as morphine, hydrocodone (Vicodin® ), and fentanyl (Duragesic® ). Ketamine is another one of the core drugs used in our topical pain cream formulations.

9.)Ketoprofen – Concentrations of 5-10% are commonly prescribed. Ketoprofen is a NSAID and provides excellent relief for acute inflammation and swelling resulting from soft-tissue and skeletal muscle injuries. It should be included as an ingredient whenever inflammation is suspected. Ketoprofen cream is particularly effective for treating arthritis inflammation in the back, hands, knees, or other joints. Ketoprofen cream is also effective for patients with gouty arthritis.

10.)Orphenadrine – Orphenadrine is a muscle relaxant with NMDA antagonist activity. Topical concentrations used are 5-10%. It is reported to block pain transmission and cause muscle relaxant effects.

11.)Pentoxifylline – Pentoxifylline is a Tumor Necrosis Factor antagonist (TNF-1α). Tumor necrosis factor is a substance produced primarily by monocytes and macrophages in response to inflammatory processes such as arthritis. Topical pentoxifylline reduces inflammation by inhibiting TNF at the cellular level. It is a useful ingredient whenever inflammation is present. Sciatica and neuropathic pain also respond well to pentoxifylline administration. Concentrations used are 5-10%.

12.)Piroxicam – Piroxicam is a potent NSAID. Like other NSAIDs, it provides relief for acute inflammation and swelling resulting for soft-tissue and skeletal muscle injuries. Topical concentrations used on 0.5 - 1%. We frequently combine piroxicam and ketoprofen for patient’s whose pain is primarily inflammatory in origin.

13.)Tetracaine & Lidocaine – Both of these drugs are local anesthetics that have neuron membrane stabilizing effects. Lidocaine is currently available as a 5% transdermal patch (Lidoderm® ) approved for management of postherpetic neuralgia. Tetracaine concentrations used in the pain formulations are 1-2%. Lidocaine concentrations used are 2-5%. *Due to the medications used in formulating our Transdermal Pain Cream, this medication is available by prescription only.
Transdermal creams only penetrate the skin and affected areas; negligible amounts of active ingredients enter the bloodstream and may affect the rest of your body. When medicine is taken orally, the body uses the GI tract to break down the drugs; as a result, most of your body is then affected as the drugs travel throughout your bloodstream. Therefore, the potential risks for side effects are minimized with the use of Transdermal Pain Cream.
Our Transdermal Pain Cream can used for various pain management symptoms including:

1.) Arthritis

2.) Fibromyalgia

3.) Plantar Fasciitis

4.) Failed Back Syndrome

5.) Neuropathic Pain

6.) Tendonitis

7.) Shingles Pain

8.) Diabetic Neuropathy

9.) Myofascial Pain

10.) Back Pain

11.) Bursitis

12.) Muscle Sprain

13.) Post-Surgical Pain

Dermatomes are areas of the skin that are stimulated by nerve impulses; these impulses follow a track from a place on our body to the spinal cord, entering the spinal cord near the vertebrae. Dermatomes are often an ignored location on the body that can potentially assist in pain relief.

Doctors use their knowledge of dermatome map to examine areas of pain and dysfunction. The mpa helps to locate the specific nerve(s) that give rise to your pain.

The dermatome map shows the dermatome path and how each location on the body is associated with specific insertion point on our spinal column. To use the chart, locate the site of your pain and trace it to where the nerve path terminates on your back. When applying your Transdermal Pain Cream to the site of pain, apply a small amount to corresponding site on your back.

For example, if you had burning pain sensation in the upper outer aspect of your thigh and there is no physical injury/damage, then the problem might be with the sensation that your leg feels. Since we know where the pain is being sensed, we can tell which dermatome it may be associated with. Knowing the dermatome that is affected will the lead you to correct level of the spine in which the injury begins.

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