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What are the Advantages/Risks of Compounded Topical Formulas used for Treatment of Pain Management?

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By Bio-identical hormone specialist Anthony Ortiz RPH CCN

Anything from a bad mattress to an old sport injury can cause chronic pain. The problem with anything that’s chronic, pain can develop a psychological dimension once the physical problem heals. With many of these patients, there is a great probability of chemical dependency with the same pain controlling pharmaceutical agents such as Percocet, Vicodin etc… Using a specific formula designed by a doctor and compounded or created by a pharmacist creates options for the doctor. He may choose to have the patient apply the compounded pain cream on a set schedule such as 3 times a day. At the same time, advising the patient to use his oral medication for example Vicodin only if needed for break-through pain (pain in-between doses of cream application).

There are many different types of pain can be helped using a compounded pain formula.

Neuropathic pain is a complex, chronic pain state that usually is accompanied by tissue injury and nerve damage. These damaged nerve fibers send incorrect signals to other pain centers. Diabetic patients who suffer from pain in their feet have similar damaged nerve fibers. A nerve can get pinched leading to chronic carpal tunnel syndrome, and tennis elbow. The other chronic pain comes from an inflamed joint such as in Rheumatoid arthritis. In addition, non-inflammatory problems of the joints, often referred to as osteoarthritis or “wear-and-tear” arthritis also has a great deal of pain due to the loss of synovial fluid.


There are many current drug therapies that are prescribed today to control chronic pain. From Lidoderm patches, Voltaren gel, Celebrex capsules and the opiates (Percocet, Oxycontin) to mention. What are the advantages/risks of Compounded Topical Formulas used for treatment of pain management? The risks are minimal and are confined to local skin irritation. Since the medications are absorbed into the skin, the side effect profile is similar to oral dosing but the advantages are many.




For the most part, they are applied topically right on the painful site. Joints, lumbar region of the back, neck and even neuropathies of the feet are popular areas of application. As opposed to Voltaren Gel, which is used solely as anti-inflammatory, a doctor can formulate a cream that contains 2, 3 or 4 different ingredients having different modes of activity. Secondly, these compounds are tailor-made for the patient. If the doctor decides he wants less anti-inflammatory activity but more anesthetic effect, it can be easily modified. You cannot do that with traditional medications. These formulas are designed and prescribed to fit the patient’s needs. A good example is with a diabetic patient. They normally are prescribed many different medications to control blood sugar, cholesterol and heart problems. Traditionally, these patients suffer from poor circulation primarily in the hands and feet. With a condition called Peripheral Neuropathy, doctors will often prescribe a drug, Gabapentin to be given orally to control their painful neuropathies. By incorporating Ketoprofen for inflammation, Ketamine an anesthetic for a numbing effect, and Gabapentin, formulated into a topical cream or gel, the patient can get immediate pain relief.

Another unique use of these compounds is the application to either trigger points or dermatomes. The nerves coming from the spinal cord are called nerve ganglion. These sensory neurons from the ganglion supply different areas on the skin called a dermatome. Many times a herpes virus triggers an inflammation along the Trigeminal nerve axon causing a very painful condition called Trigeminal Neuralgia. The patient is instructed by the doctor or pharmacist to apply a topical compounded pain formula on two areas, the area of pain and the corresponding dermatome. Applying to the dermatome will prevent the trigeminal nerve to be innervated therefore stopping the pain at the source.

Prescribing a topical compound pain cream, a doctor can design a formula to the unique situation. Every patient has different levels of pain tolerance and present with different set of clinical data points. Allergies to oral pain formulas, opiate addictions, or taking too many oral medications, doctors must individualize treatment. Taking into account the advantages /risks, topical compounded pain formulas are another tool that should be added to the doctor’s medicine bag.


Anthony Ortiz, RPH CCN

Anthony is the owner/compound pharmacist of Atlas Drug and Nutrition. Located in North Bergen, NJ, Atlas Drug specializes in women’s health related issues.

To learn more or if you need to contact me, e-mail me at or call 888-449-5990.