Case Reports

SUCCESS WITH COMPOUNDED MEDICINE

The clinical nature of pain varies from patient to patient and by medical condition. Because each patient is unique, the use of conventional treatment may not always alleviate the pain experienced by every patient. Through compounding of topical pain relief formulations, Custom Meds can aid in customizing any patient's pain therapy regimen.

At times, a physician will treat a patient with many conventional pain relief modalities and achieve minimal results. Custom Meds' specialized experience with pain chemistry, proprietary capabilities, and interaction with a wide range of practitioners nationwide can be utilized and offer valuable insight into these unusually problematic cases. Oftentimes, the addition of a topical form of pain relief can serve as a great adjunct to any patient's pain therapy regimen.

Following are a few example case reports exemplifying the success patients have with customized compounded topical pain relief.

CRUSHING INJURY, ANKLE, 44 YEAR OLD MALE. PAIN REDUCTION: FROM 10 TO 1.

Ailment: Crushing Injury

Site: Ankle

Synopsis: 44 year old male sustained a crushing injury to his right ankle while working under a car. The patient has undergone five surgeries to repair bones, bury nerves and reattach tendons. He has also undergone several courses of physical therapy and three cortisone injections into the right ankle. For his pain, which he describes as "a constant ache with spasm and throbbing," he has been prescribed a couple different pain medications, including oral narcotics. He did not care for these because he could not function while on them.

Subsequently, the patient was prescribed a transdermal gel containing Ketamine, Gabapentin, Clonidine, Amitriptyline and EMLA. The patient was instructed to apply the gel to the affected area two to four times daily. A follow-up phone conversation two weeks later revealed that the patient was getting relief within 5 minutes after applying the gel. Relief would last for several hours.

On a typical day, using the Pain Assessment Scale, patient rates his initial pain level at 10. Within 5 minutes after application of the gel, his pain level is reduced to between 4 and 5. Within an hour or so, his pain level is further reduced to 1.

MULTIPLE BACK PROBLEMS, BACK, 35 YEAR OLD FEMALE. PAIN REDUCTION: FROM 7 TO 4.

Ailment: Multiple Issues

Site: Back

Synopsis: 35 year old female with a past history of vertebral fracture (L5), arthritis, six bulging discs (3 cervical and 3 lumbar), scoliosis and arachnoiditis. She had been to several different physicians who prescribed several different pain treatment modalities including 5 epidurals, cortisone injections into the spasmodic area (11 injections each time), oral narcotics, muscle relaxants, biofeedback and physical therapy. Her pain management physician prescribed a transdermal gel containing Ketoprofen and Cyclobenzaprine for treatment of her back pain. She reported that she obtained relief within a few minutes after the gel was applied. This relief lasted two to six hours depending on her activity level. According to the Pain Assessment Scale, she rated her pain level at 7 constantly (although there were times when it reached 10). From a level of 7, her pain level decreased to 4 to 5 within a few minutes after gel application. Use of the gel enabled her to again perform her daily living activities.

POST HERPETIC NEURALGIA, CHEST AND AXILLA, 65 YEAR OLD MALE. PAIN REDUCTION: FROM 10 TO 5.

Ailment: Post Herpetic Neuralgia

Site: Chest and Axilla

Synopsis: 65 year old male had an outbreak of Herpes Zoster. A few weeks later, he developed post herpetic neuralgia involving the right side of his chest and right axilla. He rated his pain level up around 10 at this time. His treatment consisted of multiple oral pain medications and topical creams and ointments. These all offered some pain relief, but he found it very difficult to accomplish everyday activities while on oral narcotics. His pain management physician then prescribed a transdermal gel consisting of Ketamine, Gabapentin, Clonidine, Amitriptyline and EMLA to be applied to the affected areas two to four times daily. Patient reported obtaining relief immediately after applying the gel. This relief lasted for a couple of hours. According to the Pain Assessment Scale, patient rated his initial pain level around 10. After application of the gel, his pain level was reduced to level 5.

MUSCULOSKELETAL INJURY, WRIST, 64 YEAR OLD FEMALE. PAIN REDUCTION: FROM 7 TO 2.

Ailment: Musculoskeletal Injury

Site: Wrist

Synopsis: 64 year old female suffered soft tissue injury to her right wrist when she slammed her wrist into the corner of her desk at work. She described her pain as a constant, throbbing-type pain that was very tender to touch. She had very limited mobility in the wrist joint. She saw a physician who prescribed a transdermal gel formula that consists of Ketamine, Ibuprofen, Dexamethasone and Lidocaine. She was instructed to apply this gel to her right wrist three to four times daily. The patient's pain level at the time of the accident was rated at approximately 7 on the Pain Assessment Scale. Within the first few applications of the gel, the patient was feeling much better, reporting relief was obtained within 30 minutes after the first application, reducing her pain level to 4 with relief lasting a couple of hours. Follow-up one month later ascertained that the patient was again able to play tennis without any problem. She still had some mild pain (pain level 2); however, it was completely resolved with an application of the transdermal gel formula.

NEUROPATHY (POSSIBLE DIABETIC NEUROPATHY), FEET, 68 YEAR OLD FEMALE. PAIN REDUCTION: FROM 10 TO 1.

Ailment: Neuropathy (possible diabetic neuropathy)

Site: Feet

Synopsis: 68 year old female had experienced sudden bilateral foot pain 13 years earlier. She stated that her pain was so bad that she could not even walk. Over the years, she had seen a few physicians, including a chiropractor for her condition. She was prescribed many different forms of treatment, including pain medications (Darvocet), antidepressants and nerve blocks. All of these were helpful for a short period of time. Ultimately, at a time when she was experiencing a pain level of 10, she was referred to a physician specializing in pain management. A transdermal gel consisting of Ketamine 15% and Lidocaine 5% was prescribed to be applied sparingly to the affected area 2 to 4 times daily. Patient reported obtaining relief within 10 to15 minutes of applying the gel with this relief lasting 3 to 4 hours with each application, reducing the pain level to 1 on the Pain Assessment Scale.

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