David S. Klein, M.D.

Transdermal Medication
for the Treatment of Peripheral Nerve Entrapment

NOTE:  New approach in medication delivery.

Peripheral Neuropathic Pain

The treatment of peripheral neuropathy can be of the most frustrating of all medical conditions.  The use of oral medications can be expected to provide some or partial relief, but rarely does the use of oral medications provide complete pain relief.

Through the use of transdermal anti-convulsants, co-administered with transdermal anti-inflammatory agents, many peripheral neuropathies can be successfully controlled.  The concept is simple.  Through the topical/transdermal approach, higher concentrations of medication can be achieved than is possible through the oral route.  That is, if 100 mg of medication "X" is given orally, the volume of distribution, or the volume of the body to which it is delivered is the entire body.  When 100 mg of the medication is used topically, the entire amount is delivered to the area of pathology, permitting very high tissue concentrations.  When medications are delivered in the proper transdermal base, to the precise locus of pathology, pain relief can be observed in less than a minute.

The choice of transdermal base is probably more important than is the choice of agent.  The base must be matched to the intended area of application, whether it is bursa, tendon, nerve, muscle, skin or joint.  The selection of base is the starting point, and from there, the agent is chosen with the target tissue in mind, suitable for the base.

This is not terribly complicated, but it takes some experience to put the pieces together properly.  These topical medications are made individually for the patient, that is, custom compounded.  The selection of compounding pharmacist is one of the most important choices, in that most pharmacists have little or no training in this field.  There is an art to the compounding of medication, and it takes training after pharmacy school to learn the techniques.

More to come.......

I will discuss individual disease states & medication selections for them.

DSK

Suggested Resources:

IACP  -This is the International Academy of Compounding Pharmacists.  This is the professional organization for pharmacists that compound on a regular basis.  They maintain a roster of qualified pharmacists.  Like everything else, qualification does not guarantee skill, but it is a good place to start.

Pharmacy Specialists, Maitland, FL -This is the compounding pharmacy that does most of my work.  They fill prescriptions from all over the country, and I have given them the bulk of my patient's coumpouned prescriptions for many, many years.  Sam Pratt, RPh is the principal pharmacist, and he is remarkably skillful &  knowledgable.  This pharmacy does the highest quality work. There are others, and I will try to list them as well.

Pharmacy Specialists
393 Maitland Avenue
Altamonte Springs, FL 32701
(407) 260-7002

Home Iontophoresis using the EMPI Action Patch-

The EMPI company has introduced a patch-device that is quite useful for the treatment of entrapment neuropathies.  Using a time-tested technique of iontophoresis, which involves the administration of medications through the skin using electrical energy to 'push it,' technology has evolved to permit the application at home, rather than at the physician or physical therapy office.

The potential for savings is enormous, and the time saved should more than pay for the sing-use pad and medication.

more to come.   dsk

David S. Klein, MD, FACA, FACPM, FACMIMS
Director, Pain Center of Orlando
www.suffernomore.com