Compounding for Pain! What is that?
Sometimes a commercially prepared drug isn’t right for you: The dose is too high, the pill is too large, or it contains additives that you’re allergic to. Sometimes the drug you rely on is suddenly in short supply or discontinued! This is when it’s handy to know a Compounding Pharmacist.
Compounding is the art and science of creating a pharmaceutical product that fits the unique needs of a patient (either human or animal) when a commercially available drug does not meet those needs. Compounding Pharmacists are able to adjust many medications to meet your unique health requirements and preferences.
Compounding creams for pain:
Pain management is by far one of the most common reasons people visit their family doctor. Pharmaceutical pain options are challenging, as tolerance (the body gets used to a drug and the dose must be increased), dependence (withdrawal symptoms occur if the drug is stopped), risk of severe side effects, and interactions with other medications, are common. Fortunately, experience and research in recent years suggests that using topical creams or transdermal patches are often just as effective and sometimes safer than taking pain medications by mouth (i.e. absorbed through the digestive system instead), or intravenously.
Here are some of the advantages of compounding topical and transdermal pain medications:
- You can apply it directly to the affected site
- Systemic (whole-body) side-effects and drug dependency risk is reduced
- We can combine multiple drugs into one preparation and keep adjusting the formula according to your changing needs
Several types of pain respond to treatment with compounded topical or transdermal pain preparations, including:
- Nerve pain, such as peripheral neuropathy, trigeminal neuralgia, and neuralgia following a herpes infection
- Joint and muscle pain, including from rheumatoid or osteoarthritis, neck pain, back pain, and muscle spasm
- Systemic pain conditions, such as fibromyalgia
Information for your Medical Doctor:
Some of the more common topical pain combinations include an NSAID like Diclofenac (Voltaren) or Ketoprofen, with a muscle relaxant like Guaifenesin or Baclofen to manage joint and muscle pain. If there is an element of neuropathic pain, Amitriptyline or Gabapentin can be added to the formulation. A list of commonly used pharmaceutical ingredients in compounded pain creams is available here.
These active ingredients are generally incorporated into a cream or gel base which normally possesses a good carrying capacity, emollient characteristics and moisturizing effect. For more acute pain, which might require deeper penetration, a transdermal base called PLO Gel (Premium Lecithin Organogel) can be used to achieve a more systemic, rather than local, effect.
Compounded drugs are available by prescription only. (In Ontario, Naturopathic Doctors can prescribe some drugs, but generally not pain drugs. These prescriptions must come from your Medical Doctor.) Your Medical Doctor is welcome to contact the pharmacy directly with questions and send your prescription for preparation by a Compounding Pharmacist. Our team is happy to work closely with your Medical Doctor to deliver tailored medications and deliver individualized patient care.
We’re located on Weller Avenue, beside Kingston Community Health Centres, and we’re open 7 days a week:
263 Weller Ave #2,
Kingston, ON K7K 2V4
P: 613.507.9700; F: 613-507-9702
info@wellerpharmacy.com
by Tarek Hussein, Compounding Pharmacist and Manager of Weller Pharmacy
Resources:
Frequently Asked Questions about Pharmaceutical Compounding, by the American Pharmacists Association.
Dooms, M., Carvalho, M. Compounded medication for patients with rare diseases. Orphanet J Rare Dis 13, 1 (2018)
Taylor, S., Hays, C., & Glass, B. (2018). Compounding medications in a rural setting: an interprofessional perspective. Journal of multidisciplinary healthcare, 11, 197–204. https://doi.org/10.2147/JMDH.S156161
National Academies of Sciences, Engineering, and Medicine; Compounded Topical Pain Creams: Review of Select Ingredients for Safety, Effectiveness, and Use. Washington (DC): National Academies Press (US); 2020 May 13. 3, Fundamentals, Use, and Common Ingredients in Compounded Topical Pain Creams.
Compounding products and resources for compounding pharmacists: Fagron, Medisca, and PCCA.
Reyzelman AM, Vartivarian M, Bazarov I, Horne B. A Randomized, Double-blind, Placebo-controlled Study of a Topical Analgesic Cream for the Treatment of Neuropathic Pain. The Pain Practitioner. 2014 Fall;24 (3): 5-15.
K L Crowley, J A Flores, C N Hughes, R P, Lacono, Clinical Application of Ketamine Ointment in the Treatment of Sympathetically Maintained Pain, International Journal of Pharmaceutical Compounding 123, Vol.2 No. 2 March/April 1998.
