Patient Education

How Does a Compound Work?
The pharmacist blends a combination of FDA approved drugs dependent on which script he or she is filling and uses a medium, such as Lipoderm, to act as the driving vehicle for the drugs into the skin.  The patient applies the cream to the affected painful area then applies the compound and the drugs penetrate the skin topically.  When medicine is taken orally, the body uses the central nervous system to break down the drugs. The compounds only penetrate the skin and are not absorbed into the bloodstream.

Conditions Treated
One of the primary advantages of using a topical compound is the ability to treat debilitating conditions, such as:

• CSPS/RSD
• Rheumatoid Arthritis
• Fibromyalgia
• Osteoarthritis, Plantar Fascitis, Epicondylitis
• Post Herpetic Neuralgia
• Diabetic/Chemo Induced Peripheral Neuropathy
• Failed Back Syndrome

Neuropathic pain is very difficult to treat, as once it progresses, it continues to due so, causing plastic changes in the central nervous system and changes in receptors.  The topical pain creams allow for combination of different drugs, which each act on the same receptors in different ways, to alleviate the neuropathic pain.

What Are the Benefits of a Compound?
One is the elimination of gastric side effects seen such as when one takes Aleve for pain orally.  Many patients cannot tolerate certain medications because it causes irritation to their stomachs.

Another reason would be that many patients, especially older ones, on multiple meds, such as heart medication, couldn’t take certain meds due to drug interactions.

With a topical, there is no concern of that because the central nervous system does not deliver the meds; the meds are delivered transdermally.

Acute and Chronic Pain
Pain is usually the natural consequence of tissue injury resulting in approximately forty million appointments per year.  In general, as the healing process commences, the pain and tenderness associated with the injury or suffer protracted pain that persists for months or years after the initial insult.  This pain condition is usually neuropathic in nature and accounts for a large number of patients presenting to pain clinics with chronic, non-malignant pain.  Rather than the nervous system functioning properly to sound an alarm regarding tissue injury, in neuropathic pain the peripheral or central nervous systems are malfunctioning and become the cause of the pain.

Acute pain is self-limiting and serves as a protective biological function by acting as a warning of on-going tissue damage.  It is a symptom of a disease process experienced in or around the injured or diseased tissue. Acute pain is nociceptive in nature, and occurs secondary to chemical, mechanical and thermal stimulation of A-delta and C-polymodal pain receptors.

Chronic pain, on the other hand, serves no protective biological function.  Rather than being the symptom of a disease process, chronic pain is itself a disease process.  Chronic pain is unrelenting and not self-limiting and as stated earlier, can persist to multiple treatment modalities.  If chronic pain is inadequately treated, associated symptoms can include chronic, non-malignant pain is predominately neuropathic in nature and involves damage either to the peripheral or central nervous systems.

Nociceptive and neuropathic pain are caused by different neuro-physiological processes, and therefore tend to respond to different treatment modalities.  Nociceptive pain is mediated by receptors on A-delta and C-fibers which are located in skin, bone, connective tissue, muscle and viscera.  These receptors serve a biologically useful role at localizing noxious chemical, thermal and mechanical stimuli.

Examples of nociceptive pain include:  Post-operative pain, pain associated with trauma, and the chronic pain of arthritis.  Nociceptive pain usually responds to opioids and non-steroidal and anti-inflammatories (NSAIDS).