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Compounded Pain Formulations: What is the Evidence?

Author(s):  Asbill Scott, Sweitzer Sarah M, Spigener Shuler, Romero-Sandoval Alfonso

Issue:  Jul/Aug 2014 - Volume 18, Number 4
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Abstract:  Pain syndromes are among the most widespread, costly, and debilitating of all neurological disorders. The number of patients living with chronic pain is expected to increase with the aging population and with the rise in obesity and diabetes across the nation. This type of pain is often insensitive to the traditional pain pharmacopeia or surgical intervention. Over the last 10 years the number of prescriptions that have been compounded by pharmacists has increased dramatically. There are a number of drugs in the area of pain management that have been formulated and compounded by pharmacists to treat conditions such as diabetic neuropathy, fibromyalgia, postherpetic neuralgia, joint pain, arthritis, and a variety of other conditions. A significant portion of these compounded analgesic preparations is made up of topical/transdermal dosage forms such as gels and creams. While the efficacy and doses of these drugs in systemic dosage forms have been widely established, little is known about the permeation and efficacy of these compounds from topical/transdermal gels. This review will provide an overview of chronic pain as a disease, the mechanisms of chronic pain, current treatment approaches to chronic pain, and a discussion of the drugs that are typically compounded into these topical formulations and studied in clinical trials.

Related Keywords: Scott Asbill, PhD, Sarah M. Sweitzer, PhD, Shuler Spigener BSc, Alfonso Romero-Sandoval, MD, PhD, chronic pain, inflammation, inflammatory pain, neuropathic pain, neuropathy, quality of life, mental disturbances, pain mechanisms, nonsteroidal anti-inflammatory drugs, NSAID, topical preparations, analgesic, analgesia, pain control, pain relief, anticonvulsants, GABA receptors, cyclo-oxygenase inhibitors, COX, antidepressants, neurotransmitter uptake inhibitors, serotonin, norepinephrine, opioids, mu opioid receptors, N-methyl-D-aspartate receptors, NMDA receptor antagonists, glutamate blockers, corticosteroids, nerve compression, nerve hyperexcitability, cannabinoids, THC, marijuana, selective CB1 inhibitors, alternative treatments, muscle relaxants, baclofen, cyclobenzaprine, gabapentin, amitriptyline, clinical studies, literature review


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