Pain Management

At PenCol Specialty Pharmacy, we realize that pain is the most common symptom for which individuals seek medical help. We also realize that commonly prescribed, commercially available pain relief medications often result in unwanted side effects.

The Benefits of Compounding Pain Medications

A compounding pharmacy, like PenCol Specialty Pharmacy, can provide valuable benefits to those for whom pain management has become a way of life. Through compounding, a prescribing physician and a PenCol Compounding pharmacist can customize the dosage to the exact amount the patient requires, and find a dosage form that best suits the patient’s needs… while eliminating (or significantly reducing) the undesirable side effects.

For some, pain can be chronic in nature and something they live with on a daily basis. Unfortunately, while many commonly prescribed, commercially available pain relief medications help the symptoms associated with chronic conditions such as arthritis, fibromyalgia, migraine headaches, and other nerve and muscle pain, they can also result in unwanted side effects such as stomach irritation, drowsiness, and dizziness. Most patients have come to accept these conditions as a necessary consequence of taking pain medication, but pain medication obtained from a compounding pharmacy, like PenCol Specialty Pharmacy, can provide a solution.


Lozenges/Troches are most commonly used as the delivery system for Bio-identical Hormone Replacement Therapy. These Lozenges/troches are taken buccally/sublingually (dissolved between cheek and gum) which allows the prescribed medicine to go directly into your (patient’s) system without having to go through the stomach and digestive system. This direct absorption allows doctors to prescribe this medication in lower doses. Lozenges/Troches can be flavored or unflavored.

Pain Management is an Essential Part of Care

Pain management is essential because even when the underlying disease process is stable, uncontrolled pain prevents patients from working productively, enjoying recreation, or taking pleasure in their usual roles in the family and society. Chronic pain may have a myriad of causes and perpetuating factors, and therefore can be much more difficult to manage than acute pain, requiring a multidisciplinary approach and customized care protocols to meet the specific needs of each patient.

Compounding the Optimal Solution

Optimal care may involve the use of medications that possess pain-relieving properties, including some antidepressants, anticonvulsants, antiarrhythmics, anesthetics, antiviral agents, and NMDA (N-methyl-D-aspartate) antagonists. NMDA-receptor antagonists, such as dextromethorphan and ketamine, can block pain transmission in dorsal horn spinal neurons, reduce nociception, and decrease tolerance to and the need for opioid analgesics. [Anesth Analg 2001 Mar;92(3):739-44] By combining various agents which utilize different mechanisms to alter the sensation of pain, physicians have found that smaller concentrations of each medication can be used.

Topical and transdermal creams and gels can be formulated to provide high local concentrations at the site of application (e.g., NSAIDs for joint pain), for trigger point application (e.g., combinations of medications for neuropathic pain), or in a base that will allow systemic absorption. Side effects associated with oral administration can often be avoided when medications are used topically. Studies suggest that there are no great restrictions on the type of drug that can be incorporated into a properly compounded transdermal gel. When medications are administered transdermally, they are not absorbed through the gastrointestinal system and do not undergo first-pass hepatic metabolism.

Topical and transdermal “pain formulations have wide popularity among health care providers and patients when they are used, but there are indications that not all providers are familiar with how to best prescribe them and use them. A study of 120 pain clinicians revealed that only 27% reported frequently prescribing compounded topical pain medications, with a success rate of 47%.” Topical and transdermal preparations are often preferred to oral medications due to decreased systemic side effects and the avoidance of first-pass hepatic metabolism. Dosage forms include creams, ointments, and gels; medication sticks; solutions, and sprays.

Topics in Pain Management: February 2016 – Volume 31 – Issue 7 – p 1–8

Use of Topical Pain Medications for Various Pain Syndromes

Click here to access the PubMed abstract of this article.

Commonly Requested Pain Management Preparations

• SOFT TISSUE INFLAMMATION: Lipoderm transdermal gels containing either Ketoprofen or Ibuprofen or other NSAIDs, alone or with Cyclobenzaprine HCl

• ANAESTHETICS: benzocaine, lidocaine, prilocaine, tetracaine, or BLT, in many different concentrations and forms

• MIGRAINES: Indomethacin 10% in Lipoderm Transdermal Gel

• BURNING MOUTH SYNDROME: Capsaicin 0.25mg Troche; Salicylic Acid 0.3% Mouthwash (BMS Mouthwash); Salicylic Acid 0.3% Alternate

• MOUTH PAIN: Misoprostol / Diphenhydramine Compound Oral Rinse; Tetracaine Lollipop; Diphenhydramine/Lidocaine/Hydrocortisone lollipop, Ketamine lollipop; Misoprostol/Lidocaine Oral Suspension

• SMOOTH MUSCLE SPASM: Belladonna Extract / Morphine Sulfate

• ULTRASOUND: Hydroxyethyl Cellulose 3% Aq gel; Hydrocortisone Gel

• IONTOPHORESIS: Acetic Acid 2%; Lidocaine Hcl 4% Iontophoresis solution