Neuropathic pain requires different treatment than acute pain from an injury or inflammation. Pain from damaged nerves can be difficult to treat and will not respond to typical pain medications. While oral medications can be used to treat this type of pain, topical medications have been shown to be especially effective at reducing pain while minimizing systemic effects. The combinations and strengths needed to treat neuropathic pain are often not commercially available and can only be obtained from a compounding pharmacy.
Neuropathic Pain
Neuropathic pain can come from nerve damage from an injury, from diseases, and from the use of certain drugs. This type of pain can become chronic and last for years after an injury or onset of a disease. Acute injuries can cause pain that does not last long and can often be helped with over-the-counter medications. Neuropathic pain, however, often continues for longer periods of time and requires prescription-strength treatments. Many patients can find relief from chronic pain with the right pain medications in combination with lifestyle changes. There are many non-opioid options that can provide relief while reducing the chance of negative side effects and addiction potential.
When describing neuropathic pain, patients often report a sensation that is aching, shooting, stabbing, or burning. It is different from the pain that comes from an injury like a broken bone or cut on the skin. There are also different types of neuropathic pain including allodynia and paraesthesia. Allodynia is an increased sensitivity that can lead to pain from a stimulus that normally would not be painful. Paraesthesia is when neuropathic pain is experienced without any stimulus. The American Chronic Pain Association has excellent resources for anyone suffering from neuropathic pain.
Topical Application of Pain Medication
The systemic effects of an orally administered medication can be avoided with the use of a topical gel. Topical medications are made to provide relief in the specific area where they are applied as opposed to affecting the entire body. While some pain gels are available commercially, the higher strengths and combinations are only available from a compounding pharmacy. Some drugs that can be applied topically are not available commercially in gel form because the patent on them has expired.
When applied to the skin, the medication’s rate of absorption is slowed. This leads to higher levels in the tissues as the drug stays in the area for a longer period of time. By combining multiple pain medications into one gel, less medication can be used to produce the same effects. A topical medication can also reduce side effects for patients who are sensitive to the gastrointestinal effects of oral medications like NSAIDs.
Topical Pain Gel Ingredients
In many cases, a chronic pain condition can result in multiple types of pain that each require a unique treatment. A compounding pharmacy can combine multiple ingredients into one gel to treat the different types of pain.
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- Gabapentin is one of the most commonly used medications for treating neuropathic pain topically. Gabapentin is used as an antiepileptic and to control seizures. It works to treat neuropathic pain by blocking glutamate, which is a chemical that stimulates pain receptors.
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- Ketoprofen is an NSAID that can effectively reduce inflammation and swelling when applied topically.
- Cyclobenzaprine is a muscle relaxer used for neuromuscular pain associated with multiple sclerosis and fibromyalgia.
- Lidocaine is an anesthetic that can be added to topical pain gels to further reduce the sensation of pain.
Example Formulations
Each ingredient is available in its own formulation. For example, we frequently compound gabapentin pain gel in 5-10% strengths.
| Gabapentin | Lidocaine | Ketoprofen | Clonidine | Cyclobenzaprine | |
| Compound 1 | 10% | 10% | 10% | – | – |
| Compound 2 | 6% | – | 15% | – | – |
| Compound 2 | 6% | – | – | 0.2% | – |
| Compound 4 | – | 5% | 20% | – | 2% |
New Advances: 4-AP for Peripheral Nerve Damage
A recent study on mice showed that the drug 4-aminopyridine (4-AP) effectively repaired nerve damage from injury. 4-AP has been used for many years to treat chronic conditions like multiple sclerosis. This new use for a proven medication may be an effective alternative treatment for nerve damage. Compounded 4-AP is much more affordable than the commercially available version that is approved for improving mobility in MS patients.