Topical Medications: Pain Relief Beyond Skin Deep
Delivering medication to the source of pain is often accomplished by taking a pill. The chemicals in the pill get absorbed into the system and can then attack the pain. Sometimes this oral route of medication delivery is not the best way. Sometimes a topical medication is more appropriate for an individual pain treatment plan.
Ideal candidates for topical medications include anyone sensitive to the systemic side effects from oral medications. Examples include anyone taking multiple medications that may interact with a new pill or anyone with renal or liver impairment. Elderly people are also particularly sensitive to the side effects from oral medications. And some people have ongoing cardiovascular or gastrointestinal reasons to avoid certain oral medications. These scenarios are all times when a topical medication might be more appropriate. In fact, occasionally a topical medication will work better than an oral medication for difficult-to-treat, refractory pain.
Unfortunately, topical pain medications are not widely available on the commercial market. A few anti-inflammatory topicals like Pennsaid, Flector Patch and Voltaren Gel are widely available with a prescription. These products are most useful for musculoskeletal injuries or arthritic pain. Another commercially available topical contains lidocaine. The lidocaine patch is useful for conditions like bursitis or postherpatic neuralgia. The limited choices on the commercial market should not limit the possibility of topical medication use.
Besides what is available commercially, so many other medications are also useful in topical preparation. Such topical medications are available through compounding pharmacies. For pain generated by the nervous system like peripheral neuropathy pain, medications like amitryptyline, ketamine, clonidine, baclofen, and/or gabapentin can be used topcially. These ingredients are usually combined in various percentages to create a specially formulated topical preparation. For pain related to inflammation or muscle pain, drugs like lidocaine, ketoprofen, aspirin, and/or cyclobenzaprine are used to provide local pain relief. A good compounding pharmacist will be full of ideas about how to individualize treatment for even the worst cases of pain.
But before you rush out to get the latest concoction from your compounding pharmacist, check with your insurance company or you may experience some sticker shock from the high prices attached to custom topical pain relievers. Most companies will pay for commercial products with prior authorization, but the custom, compounded topical medications may not be paid for by your insurance company. However, good pain relief might be worth an out-of-pocket price. If you need an alternative to oral medications, consider the wide array of topical medications available to treat the pain beyond skin deep.
Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.