Pain Medicine Compounding
By Brittany A Duke, PharmD
Medically reviewed by Rosanna Sutherby, PharmD
Are you among the 20% of Americans who experience chronic pain? Or are you one of the 8% of Americans who experience “high impact” pain, which affects your work and quality of life? If you are, pain management through pain medicine compounding can help you return to work and your regular activities. Read on to learn:
- Why you need pain medicine compounding
- Which types of pain can be treated by your compounding pharmacy
- What common pain medications are compounded
Why Do You Need Pain Medicine Compounding?
Everyone experiences pain and pain relief differently. In many cases, conventional treatments provide inadequate pain relief, especially if your dose is too low or you have difficulty swallowing the medication. On the other hand, if your dose is too high, you may experience unwanted side effects.
Compounding pharmacists can prepare personalized compounded pain medications in exact dosages, safe combinations, and customized delivery systems. Compounded pain medicines offer you the right amount of medication for optimal pain relief and minimum risk of side effects.
What Types of Pain Do Compounding Pharmacies Treat?
The following are examples of different types of pain that may be managed with compounded medicines:
- Neuropathic pain: Neuropathic pain results from damage to your nervous system.
- Complex regional pain syndrome (CRPS): CRPS is chronic pain that typically affects one arm, hand, leg, or foot.
- Diabetic neuropathy: Diabetic neuropathy is nerve damage caused by diabetes.
What Common Pain Medications Are Compounded?
Medications typically used for treatment of neuropathic pain include the following:
- anti-seizure medications, including gabapentin
- capsaicin
- local anesthetics, such as lidocaine gel
- tricyclic antidepressants, such as amitriptyline
Medications used to manage CRPS include:
- anti-seizure medications
- beta-2 agonists, such as clonidine
- local anesthetics
- NMDA receptor antagonists, such as ketamine
- nonsteroidal anti-inflammatory drugs (NSAIDs), such as diclofenac
- tricyclic antidepressants
Diabetic neuropathy can often be treated with clonidine and compounded topical creams, including the following:
- amitriptyline
- baclofen
- bupivacaine
- gabapentin
- ketamine
Let’s take a closer look at some commonly compounded medications used for pain management.
Diclofenac
Diclofenac is an NSAID that is used to treat mild to moderate pain. It is typically used to manage symptoms related to rheumatoid arthritis or osteoarthritis and for menstrual cramps. Additionally, diclofenac powder can be used to treat migraine headaches.
Baclofen
Baclofen is a muscle relaxant typically used to treat muscle spasms, pain, or stiffness related to multiple sclerosis. When used as a topical cream, baclofen can target specific areas and has fewer side effects than oral formulations.
Cyclobenzaprine
Cyclobenzaprine
Cyclobenzaprine is a muscle relaxant that may be used in combination with physical therapy to treat muscle spasms and pain due to injury. Compounded cyclobenzaprine cream allows you to selectively treat your specific painful areas.
Lidocaine
Lidocaine is a potent pain medication. Lidocaine cream is often used to numb your skin before tattooing and other painful procedures.
Verapamil
Verapamil is a blood pressure medication that can be used to treat heart rhythm problems and chest pain. Compounded verapamil cream allows you to easily adjust and customize your dose.
Ketamine
Ketamine blocks pain sensations directly in your brain. It is often used as an anesthetic before surgery.
Clonidine
Clonidine is a blood pressure medication that is also used to treat some types of neuropathic pain. Clonidine patches or cream can target specific problem areas.
Gabapentin
Gabapentin is an anti-seizure medication that can also help with restless leg syndrome and other types of pain. It is frequently used to treat nerve pain related to diabetes, the herpes virus, or shingles.
Indomethacin
Indomethacin is an NSAID that is useful in treating arthritis and inflammatory conditions, such as the following:
- ankylosing spondylitis
- bursitis
- gout
- osteoarthritis
- rheumatoid arthritis
- tendinitis
Summary
Compounded pain medications can be the difference between inadequate pain relief and living pain-free. Your compounding pharmacist can customize your pain medication to deliver the best dose for your pain relief in a formulation that works for you.
About Author:
Dr. Brittany A Duke is a Pharmacist and freelance health writer with over 5 years of experience in medical writing. Prior to her new position as a Global Regulator Manager for Bristol Myers Squibb, she worked at the FDA for 4 years. At the FDA, she was a Medical Writer for the Office of Surveillance and Epidemiology, Division of Medication Error Prevention and Analysis, Rapid Response Team. There, she was responsible for the development of regulatory documents including guidance, regulations, policies, and procedures that affect the drug approval or post market product safety surveillance and evaluation process.
References:
- Dahlhamer J, Lucas J, Zelaya C, et al. Prevalence of chronic pain and high-impact chronic pain among adults – United States, 2016. Morbidity and Mortality Weekly Report (MMWR). September 14, 2018;67(36):1001–1006. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016 | MMWR (cdc.gov)
- National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on the Assessment of the Available Scientific Data Regarding the Safety and Effectiveness of Ingredients Used in Compounded Topical Pain Creams, Jackson LM, Schwinn DA, eds. Compounded Topical Pain Creams: Review of Select Ingredients for Safety, Effectiveness, and Use. Washington (DC): National Academies Press (US); May 13, 2020. https://pubmed.ncbi.nlm.nih.gov/32780578/
- Diabetic Neuropathy. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/symptoms-causes/syc-20371580. Published March 3, 2020. Accessed June 29, 2021.
- Complex Regional Pain Syndrome. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/crps-complex-regional-pain-syndrome/symptoms-causes/syc-20371151. Published February 18, 2020. Accessed June 29, 2021
- Jamero D, Borghol A, Vo N, Hawawini F. The emerging role of NMDA antagonists in pain management. US Pharm. 2011;36(5):HS4-HS8