In certain cases, a physician may recommend a patient use a topical opioid or a custom-blended topical medication made at compounding pharmacies.
Compounding Pharmacy Options
Specially compounded topical medications are custom-made for specific patients. These may be appropriate when commercially available medications cannot meet the needs of the patient. For example, the patients may:
- Need a specific dosage
- Require a different form (e.g. patch vs. pill)
- Have allergies to certain ingredients in manufactured medications
Custom medications may contain a single active ingredient (e.g. ibuprofen) or a combination of active ingredients. For example, a compounded topical cream to treat musculoskeletal pain may contain a NSAID, such as flurbiprofen, and a numbing agent, such as bupivacaine.16
Compounded medications are expensive and may not be covered by insurance.
Compounded topical medications: side effects and warnings
Because these medications are custom made, their risks may not be recognized or well known. This lack of information does not necessarily mean compounded topical medications are more dangerous than other medications, just that more research is needed.
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Prescription Topical Opioids
Topical opioids are not often used to treat arthritis-related pain, but might be appropriate in certain situations. For example, a physician may prescribe a topical opioid if a person cannot take oral opioids and:
- Has severe back pain associated with arthritis of the spine
- Is recovering from joint replacement surgery
Topical opioids are an alternative to oral (pill form) opioids. Oxycodone, morphine, and hydromorphone can be compounded for topical pain relief. All opioids (commonly called narcotics) are reserved for treatment of severe pain.
Opioids: potential side-effects
Experts advise prescribing physicians and their patients to use any opiates judiciously because of potential side effects, such as (but not limited to) brain fog, fatigue, and the potential for addiction.
Like all prescription medication, topical pain relief products are potentially toxic should be kept away from pets and children.
- Somberg JC, Molnar J. Retrospective Evaluation on the Analgesic Activities of 2 Compounded Topical Creams and Voltaren Gel in Chronic Noncancer Pain. Am J Ther. 2015 Sep-Oct;22(5):342-9. doi: 10.1097/MJT.0000000000000275. PubMed PMID: 26352120.