Transdermals for Pain:
Maximize the Relief, Minimize the Side Effects
Transdermals are applied topically the form of gels or patches. With the exception of a few mass-marketed patches, such as Duragesic and Lidoderm, effective gels for pain need to be custom-made with special equipment by your compounding pharmacist.
Why use transdermals? "All drugs taken orally have the potential to irritate your stomach and produce unwanted side effects such as nausea and GI upset," said Nicholetti. "In addition, blood levels can cause side effects when many drugs are taken orally."
So, even if you are limited by the side effects of a given drug due to its effect on your stomach or the systemic effects caused by its presence in your blood, you can still benefit from the medication by applying it topically at the site(s) where you hurt the most.
What are the most common orders Nicholetti gets for FMS patients? "Listing them in order or perceived effectiveness, it would be ketamine, gabapentin, amitriptyline, and clonidine," says Nicolietti. He adds that the drugs often prescribed for FMS are the same as those used for neuropathic pain conditions; whereas if the person has arthritis, he usually receives a request for an anti-inflammatory drug such as ketoprofen or ibuprofen. "But some doctors prescribe drugs for neuropathic pain and inflammatory pain because with FMS they don't always know where the pain is coming from.
"Don't expect to apply your new gel and feel like a million bucks," says Nicoletti. "People usually need to apply the gel three times a day and it could take five-to-seven days to get the maximum effect. You didn't get the pain overnight, and chances are it won't go away overnight either."
[While there are almost 100 compounding pharmacists in the DFW area,] if you can't locate one in your neighborhood, you and your doctor can always use Prescription Lab Compounding Pharmacy's toll-free number to have your topicals delivered directly to you. Their number is (800) 291-6099. Your doctor can call in your prescription and you can call them with your credit card for payment and shipping instructions.
In the original article, pharmacist David Nicoletti listed the 18 drugs most frequently prescribed by doctors for topical gels, along with the recommended dosage range. To obtain a copy contact Carol at 817-283-1115 or lsieverl@flash.net.
Excerpted with permission from the article "What Your Compounding Pharmacist Can Do For You," Fibromyalgia Network, Inc., July 2000 (Issue #50), P.O. Box 31750, Tucson, AZ 85751, 1-800-853-2929 or www.fmnetnews.com, $25.00 per year/$27.00 in Canada.
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