Pain Therapy

COMPOUNDED TRANSDERMAL MEDICATIONS FOR PAIN

(Pain Creams and Gels)

Background

A new type of pain reliever, Motrin (ibuprofen), was introduced in the U.S. thirty years ago.  Motrin was first used in England and belongs to a new class of drugs called Non-Steroidal Anti-Inflammatory Drugs (which quickly became known by their acronym NSAIDs).  Since that time many other NSAIDs have been introduced in the U.S. 

NSAIDS when used in lower doses, provide pain relief comparable to Tylenol and aspirin.  When used in higher doses, they also provide anti-inflammatory relief.   Unfortunately, at these higher doses they can also cause unwanted side-effects such as nausea, vomiting, dizziness, and even ulcers with long-term use.

As a way of minimizing these side-effects,  European companies started marketing transdermal NSAID gels and creams over 15 years ago.   Many studies have proven these transdermal compounds to be both effective and safe.  Presently, no companies market this type products in the U.S.

Transdermal compounds are not completely without side-effects.  Like many topically applied products, they have the ability to produce a dermatitis reaction or cause sun sensitivity.  Because the most common gels have lecithin in them, they should not be used by people who are allergic to egg whites.

For more info on how transdermals work click here.

FORMULATIONS

There are a wide variety of compounded NSAIDs available on prescription  The most common are ketoprofen and diclofenac.  Specialists often combine them with anesthetics (lidocaine, ketamine), neuroleptics (carbamazepine, gabapentin), muscle relaxants(cyclobenzaprine), and other analgesics(capsacin).

The most commonly prescribed topical NSAID in the U.S. is probably Ketoprofen 10% in PLO gel. Ketoprofen is available in oral form as the commercial product Orudis. PLO is an abbreviation for Pluronic Lecithin Organogel, a unique formulation which allows some medications to be absorbed through the skin. For more info on how PLO works.

      The most common prescription for a topical NSAID gel is:

      Rx Ketoprofen PLO Gel 10% 30 gram (1oz) or 60 gram (2oz)

      Apply 3 times a day

The usual amount needed to provide relief is ¼ teaspoonful or enough to cover the affected area.  It is advisable to wash the area first with warm water.  Wrapping the area with an occlusive wrap (Saran Wrap) seems to increase the effectiveness.  Gently heating the area may also increase absorption.