Topicals

One class of medication that I’ve mentioned a few time in other posts is topical medication.  Topical means that the medication is applied to the skin, directly over the painful areas, as opposed to being taken in a pill or other formulation.  There are some nice advantages to using topical medications: they go directly to where the issue is, and they are absorbed in small levels, meaning that the likelihood of side effects is much lower.  Many of my older patients or patients who already take a lot of medications find that a topical ointment or cream is the best option for them.

The most common topical medication I use is probably lidocaine.  Lidocaine is a local anesthetic, which means that it is a numbing medication.  It comes in many different strengths, some of which are over the counter, and some of which are prescription only.  Topical lidocaine can be formulated in a gel, an ointment, or even a patch. Unfortunately, insurance coverage changes have made it very difficult to get the patch, and now I can only really use it for patients who have post-herpetic neuralgia (shingles pain, which I discussed in an earlier post). I recommend lidocaine for a lot of different issues like muscle pain, nerve pain and joint pain.  

There are also topical anti-inflammatory medications available.  Diclofenac is probably the best known (Voltaren is the brand name).  Unfortunately, insurance companies have cracked down on the use of this quite a bit too! (And yet, they’re happy to pay for morphine…more on this in another post).  It has become very difficult to get this medication covered, and many of my patients pay for it out of pocket or bring it back from other countries when they travel, because it is over the counter there.  I find that Diclofenac is a great choice for muscle sprains/strains and joint pains.

Capsaicin is another topical treatment that is derived from chili peppers.  It interferes with pain pathways that signal pain through the nervous system to the brain.  It works very well, but a lot of my patients don’t enjoy that it tingles and sometimes burns when it starts working!

If I want to mix a few different medications together into one topical treatment, I use a compounding pharmacy to help with this.  A compounding pharmacy is a specialized pharmacy that will create blends from scratch using my directions. One blend that works well for many patients is an anti-inflammatory/lidocaine combination, which saves the patient from having to use two different ointments.  When patients have severe nerve pain, I will often add nerve pain medications to the mix as well. I can even put a muscle relaxant into the ointment if I think that muscle spasm is contributing.

The downside of these compounded medications is that not every prescription plan has coverage for compounding pharmacies, and so sometimes it can get prohibitively expensive to use them.  

If you’re wondering if a topical treatment might be right for you, make an appointment with a pain management specialist!  We are familiar with lots of different options and can help make the right decision for you, including a customized blend at a compounding pharmacy. Don’t forget to subscribe using the button above so that you never miss a post.