Pain Creams in Private Practice The purpose of this presentation is to educate physicians on the best uses through practical application of Transdermal Pain Creams.

Important Definitions and Concepts Compounding: Formulas designed to help physicians customize medication to meet the patients specific needs. Pain Creams: a misnomer. These creams are much more than Analgesic Cream.

Benefits of Compounding All transdermal pain creams are compounded on a patient-by-patient basis Our compounding pharmacies offer proven expertise, significant experience and high quality control standards Each formulation is specific to the recipient, tailored to doctors’ specifications based on individual needs, and may include a range of medications Our formulas have been created by a team of microbiologists, biochemists and pharmacists; working closely with our physicians to provide the widest range of care for the many conditions your patients are suffering with.

What Do Pain Creams Treat? Neuropathic: * Diabetic * Post-herpetic * Chemotherapy Musculoskeletal: * Joint * Ligamentous * Cartilaginous * Musculoskeletal Arthritic Conditions: * Osteoarthritis * Rheumatoid * Gouty

Pain Creams are Non-Narcotic Therefore Eliminate Addiction An Alternative Choice To: *Oral Medication *Injectable Pain Medication (C-2’s) Avoid unwanted ingredients, such as dyes, preservative, lactose, gluten, or sugar Obama Care Mandates

About our Pharmacy Team Our pharmacies are considered innovators in the field of Compounded Medications. Our goal is to continually search for the most cutting edge formulations designed at improving overall health and quality of life for the people in their community. We continually survey our physician and patient base, seeking input and feedback so that the team pharmacists and biochemists can meet all those needs individually and collectively. Our formulary consists only of FDA approved ingredients and the highest standards of compounding effectiveness.

Our Pharmacists Use Different Ingredients & Address EVERY Aspect Of Patient’s Condition: NSAIDS (Non-Steroidal Anti-Inflammatories) Beta Blockers to relax smooth muscle contractions Gabapentin for neuropathies and myopathies Analgesics and Anesthetics specifically for pain modulation ….but we DO NOT USE ANY C2 narcotics

Reduction in side effects Lack of Gastrointestinal side effects Fewer systemic side effects Localized relief of pain and inflammation Dose reduction Reduced addictive potential Increased adherence/patient compliance Topical Versus Oral Benefits

Available Medications Amitriptyline Baclofen Bupivacaine Camphor Capsaicin Clonidine Cyclobenzaprine Flurbiprofen Gabapentin Imipramine Ketamine Lidocaine Menthol Nifedipine Pentoxifylline Tramadol

Amitriptyline – A tricyclic-antidepressant that inhibits the membrane pump mechanism responsible for uptake of norepinephrine and serotonin. Pharmacologically this action may potentiate or prolong neuronal activity, since uptake of these biogenic amines is important physiologically in terminating transmitting activity Baclofen – A muscle relaxer and an antispasmodic agent, used to treat muscle symptoms caused by multiple sclerosis, including spasm, pain, and stiffness. Bupivacaine – A local anesthetic with double the duration of lidocaine. It works by acting as a sodium channel blocker, working to prevent ectopic neuropathic impulses. It also has anti-inflammatory properties. Camphor – Used topically to increase blood flow and as a counterirritant, which reduces pain, itching and swelling by caused by irritation.

Capsaicin – Used for temporary relief of muscle or joint pain caused by strains, sprains, arthritis, bruising or backaches. Also used topically to treat nerve pain in people who have had shingles Clonidine – Typically used to lower blood pressure, Clonidine has been shown to produce a minor degree of nerve blockage at high concentrations. Cyclobenzaprine – A muscle relaxant that works by blocking nerve impulses (or pain sensations) that are sent to the brain. Cyclobenzaprine is used together with rest and physical therapy to treat skeletal muscle conditions such as pain or injury. Flurbiprofen – A non-steroidal anti- inflammatory drug (NSAID), Flurbiprofen has analgesic, anti-inflammatory, and antipyretic action. It acts by inhibiting Prostaglandin (PGs) synthesis and their release at the site of injury.

Gabapentin – An anti-epileptic medication (anticonvulsant). May be used with other medications to treat partial seizures in children 3 to 12 and used in adults to treat nerve pain caused by the herpes virus or herpes zoster (shingles), and to treat restless legs syndrome (RLS). Imipramine – Imipramine is in a group of drugs called tricyclic antidepressants. Imipramine affects chemicals in the brain that may become unbalanced. It is used to treat symptoms of depression and can also assist in nerve relaxation. Ketamine – Ketamine is an anesthetic medication. It is used as a general anesthetic to prevent pain and discomfort during certain medical tests or procedures or after minor surgery. Lidocaine – A local anesthetic, Lidocaine topical is used to reduce pain or discomfort caused by skin irritations such as sunburn, insect bites, poison ivy, poison oak, poison sumac, and minor cuts, scratches, hemorrhoids and burns.

Menthol – Used topically, it causes coolness due to stimulation of cold-sensitive TRPM8 receptors. It may also yield analgesic properties via kappa-opioid receptor agonist Nifedipine – A calcium channel blocker that works by relaxing the muscles of the heart and blood vessels. It is used to treat hypertension (high blood pressure) and angina (chest pain). Pentoxifylline – As with other xanthine derivatives, it relaxes certain smooth muscles including those of the peripheral vessels, thus causing vasodilatation, preventing spasms. Tramadol – A mild opioid agonist, norepinephrine and serotonin reuptake inhibitor, as analgesic proposed for the treatment of moderate to severe pain and acute musculoskeletal pain. It may also be used in conjunction with NSAID therapy for patients with osteoarthritis.

Identifying Patient Candidates Using Applicable Formulas Anti-Inflammatory

Identifying Patient Candidates Using Applicable Formulas Neuropathy

Identifying Patient Candidates Using Applicable Formulas Deep Muscle Pain