Topical treatment of neuropathic pain using compounded medications.

BACKGROUND: The current medical treatment of neuropathic pain (NP) is inadequate with more than two thirds of patients having no suitable solution for their morbid disease and deteriorating quality of life. Currently, medications for the treatment of NP are mostly systemic (affecting the central nervous system) and are dose limited because of serious and debilitating adverse effects. Scientific evidence suggests that localized cutaneous NP can be treated effectively and safely by topical medications; however, only a few topical medications are indicated for NP. This lack of topica medications stems from the limited resources that have been dedicated to exploring the role of the peripheral nervous system in NP or to the development of peripherally active topical analgesics.
OBJECTIVES: To explore the evidence supporting the role of topical medications and the role of an expert compounding pharmacist in compounding effective and safe topical preparations to treat NP.
METHODS: A narrative review.
RESULTS: Well-designed randomized control trials and increasing number of case reports have shown positive results regarding a few topical compounded medications for the treatment of various pathologies of NP. This review summarizes the relevant scientific data supporting the use of topical medication in treating certain types of NP. DISCUSSION: This article discusses the role of topical medications in treating localized cutaneous NP and the role of the compounding pharmacists in applying this therapeutic approach (eg, the scientific considerations that the pharmacist should take into account).