Each year, millions of Americans visit their physicians to seek help with painful conditions such as arthritis, diabetic neuropathy, fibromyalgia, and nerve or muscle pain resulting from injury. Depending on the severity and duration of the pain, suffering can have a dramatic impact on quality of life, causing work and financial setbacks, limiting social and leisure activities, hindering sleep, and endangering emotional well-being. Despite the number of individuals affected and the money spent on treatment, many patients find conventional drug therapy unsatisfactory and billions are lost annually in workplace productivity.
Current management of chronic pain most commonly involves oral administration of analgesics, steroids, non-steroidal anti-inflammatory agents, muscle relaxants, and narcotics. All of these may produce significant side effects in the short term, including sedation, cognitive dysfunction, nausea, and other gastrointestinal difficulties. Long term use may bring such detrimental ailments as gastric bleeding and liver toxicity. Furthermore, for many of these medications the potential exists for abuse and drug diversion. These unwanted consequences not only have lasting effects on the patient's health but can dramatically add to time away from work.
Transdermal drug delivery is an alternative method of pain management which may eliminate these problems. Collaborating together, a physician and compounding pharmacist can assess an individual patient's needs and customize a transdermal medication for a convenient, non-invasive, and generally side effect free experience. Medication delivery and dose are tailored to a specific patient considering factors such as weight, age, allergies, root causes of pain, and additional medication usage. By avoiding the digestive system with localized medication delivery, damage to the stomach, intestines, and liver may be avoided. The physical nature of the dosage form makes abuse and diversion nearly impossible.
Medications are applied and rubbed in well to areas of clean, dry skin. The patient refrains from washing the area or applying other lotions or medications for several hours to ensure maximum absorption.
Delivering a broad array of medications at various strengths requires not only specialized training and equipment but also advanced transdermal base technology. Absorption of drugs transdermally begins in the layer of outer skin and proceeds by passive diffusion through the deeper epidermal channels and the dermis. When the drug reaches the vascularized dermal layer, it becomes available for absorption into the site of action. Transdermal drugs utilizing PLO gels or lipoderm bases contain both water and lipids which enable solubilizing of agents and subsequent intracellular delivery.
Many drugs currently used in oral pain therapy work well as transdermal agents. Examples include numbing agents such as bupivacaine, lidocaine and tetracaine; steroids such as dexamethasone; non-steroidal anti-inflammatory drugs such as ketoprofen and diclofenac; muscle relaxants such as baclofen and cyclobenzaprine; circulation enhancers such as nifedipine and nerve blockers such as ketamine and gabapentin. For example, a ketoprofen 10%/lidocaine 4% PLO gel may be prescribed for joint pain, or ketamine 10%/gabapentin 6%/lidocaine 4% for the nerve pain.
While the advantages of transdermal delivery systems are numerous, less than 1% of all pharmacies are trained and equipped to provide them. From mitigating side effects and drug interactions, to minimizing abuse, to delivering drugs directly to the site of action, patients and prescribers can expect better therapeutic outcomes with personalized transdermal analgesics. There are hundreds of compounded solutions from which providers can choose for both acute and chronic conditions.