Pain affects more Americans than diabetes, heart disease and cancer combined. In 2011, at least 100 million Americans had chronic pain. Commonly reported pain conditions included low back pain, headache or migraine pain, neck pain, and facial ache or pain. Unrelieved pain can result in patients undergoing longer hospital stays, increased rates of rehospitalization, increased outpatient visits, and a decreased ability to function leading to a diminished quality of life, productivity and lost income. Pain has an impact on the overall enjoyment of life for patients with the majority reporting feeling depressed, having trouble concentrating, affected energy levels and an inability to sleep well. Annual costs of health care in the United States due to pain ranges from $560 billion to $635 billion combining medical costs for pain care and the economic costs related to lost wages and productivity. 1
Compounding pharmacy provides physicians and pharmacists an environment to collaborate and determine the best medication and dosage form for a patient on a case by case basis. This process creates a compounded medication that is tailored to fit the patient’s therapeutic needs. Transdermal compounded formulations provide physicians with the opportunity to take advantage of multimodal pain management. Several medications, with their respective mechanisms of actions, can be delivered in a single dosage formulation that provides a delivery system that limits systemic absorption and decreases the potential for drug interactions and adverse events while providing a high concentration of the drug at the site where action is needed. Typical medications seen incorporated in transdermal pain management compounds include non-steroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, antidepressants, analgesics, anesthetics, NMDA antagonists and muscle relaxants.
NSAIDs can be utilized when focusing on pain related to inflammatory processes such as ketoprofen, ibuprofen, or naproxen. NSAIDs decrease pain and inflammation by inhibiting the formation of leukotrienes and prostaglandins. NSAIDs can cause serious gastrointestinal, cardiovascular and renal side effects when taken orally. Transdermal application of NSAIDs is advantageous due to the avoidance of GI tract irritation and first pass metabolism minimizing systemic absorption and side effects while maintaining similar efficacy.2,3
Anticonvulsants and antidepressants, such as gabapentin and amitriptyline, can be used in compounds for neuropathy. Gabapentin is thought to act by antagonizing voltage-activated calcium channels and modulate the activity of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) to prevent neuron sensitivity. An advantage seen with gabapentin is its ability to reduce opioid use when added to an opioid regimen due to it being effective in reducing pain at rest and pain related to movement. The mechanism for amitriptyline’s pain relief is not known but is thought to be related to its effect on inhibiting the membrane pump responsible for uptake of norepinephrine and serotonin in adregnergic and serotonergic neurons. 4,5
In 2010, about 12 million Americans reported nonmedical use of prescription painkillers in the past year. Nonmedical use of prescription pain killers costs health insurers up to $72.5 billion annually in direct health care costs.1 The Drug Abuse Warning Network reported that 1 million emergency department (ED) visits were attributed to prescription drug abuse with more than half involving multiple drugs. Roughly 343,000 cases involved opioid pain killers, a rate that more than doubled from the previous 5 years.6 Non-narcotic transdermal pain formulations incorporating these medications would be beneficial for use in targeted pain management. This dosage form is a unique way to decrease opioid consumption and prevent prescription drug abuse.
Patients can utilize these compounded transdermal pain formulations for acute or chronic pain associated with osteoarthritis, diabetic neuropathy, musculoskeletal injuries, muscle spasms or postoperative pain. Pharmacy Specialists provides pain consultations upon physician request and can provide recommendations for the most appropriate custom compounded formulation. Pharmacy Specialists now bills most insurances directly and can provide reimbursement receipts for all other insurance needs. Contact Pharmacy Specialists at 407-260-7002 and speak with a pharmacist today.
By Juan Lopez, PharmD and Jill Weinstein, RPh
References available upon request
Juan Lopez is a PharmD graduate of Mercer University College of Pharmacy and Health Sciences and is currently on rotation at Pharmacy Specialists. Jill Weinstein, RPh, graduated from University of Florida and is the clinical pharmacist who does hormone, nutrition and weight loss consultations at Pharmacy Specialists. Pharmacy Specialists is proud to be the only pharmacy in all of Central Florida and one of only 129 pharmacies in the country that are accredited by the Pharmacy Compounding Accreditation Board (PCAB). We meet or exceed ALL standards for sterile as well as non-sterile compounding and we are the only USP 797 and USP 795 validated compliant pharmacy in all of central Florida. Currently, Sam Pratt, RPh at Pharmacy Specialists is the only Full Fellow of the International Academy of Compounding Pharmacists in the Central Florida area. Call Pharmacy Specialists to check with a clinical pharmacist for suggestions and recommendations. For additional information please call (407)260-7002, FAX (407) 260-7044, Phone (800) 224-7711, FAX (800) 224-0665.