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Workers compensation and epidemic of fatal opioid abuse

Abuse of opioids such as heroin, oxycontin and methadone led to 28,000 deaths last year, according to federal agencies. Many states are taking steps to combat the epidemic, but proposed solutions have attracted their own share of controversy and criticism. Judy Woodruff talks to Gov. Charlie Baker of Massachusetts for more on the fight against opioid abuse in his state.

By Chris Faubel, M.D.Topical compounded creams for pain

Topical administration of medications for pain management has become increasingly more common. Pharmaceutical companies are getting in the game with products such as Flector patches, Voltaren gel, Pennsaid topical solution, Lidoderm patches, and Qutenza patches. Numerous over-the-counter products also exist.

Many patients need more than just one medication to treat their pain. And for some, the adverse effects and allergies of oral medications is too much to bear. For these patients, sometimes the best solution is having a compounding pharmacy put together a number of different medications with different mechanisms of action into a compounded cream that is applied directly over the site of pain.

Benefits of Compounded Creams

Delivered directly to the pain receptors
Minimizes systemic absorption
Targets numerous pain receptors at once
Fewer adverse effects (such as renal and gastric effects from NSAIDs)
Reduces drug-drug interactions
Non-addictive formulations
Good for patients with difficulty swallowing pills
Commonly Compounded Medications for Pain

Ketamine 5-10%
Lidocaine 1-10%
Gabapentin 5-10%
Amitriptyline 2-10%
Imipramine 2-10%
Cyclobenzaprine 2%
Baclofen 2%
Clonidine 0.2%
Ketoprofen 10%
Diclofenac 2-10%
Nifedipine 2-16%
Below is an image of various drugs that are used in compounded creams for the treatment of pain conditions. Proposed mechanism of action and uses are also listed.

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