Clearing's Chronic Pain Blog

The Ins and Outs of Compounded Pain Creams at Clearing

The Clearing Team
The Clearing Team

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They come in small tubes, vials or tubs, pack a powerful punch, and can be completely personalized, if desired. They’re compounded creams — combinations of medications mixed by pharmacists in specific dosage levels to target specific needs — and some people with chronic pain find them to be quite effective. 

 How, exactly, do you get a compounded cream though? And what should you look for in a good cream? Those are great questions — let’s talk through them.

What is a compounded pain cream?

Compounded topical pain products blend active and inactive ingredients into a cream or gel base. They can be formulated to fit an overall need or customized by prescription for specific needs you may have. 

Compounded pain creams offer certain advantages, in that they don’t always have the same strong side effects as many oral pain-relief medications and may be gentler on the digestive system. The right cream can sometimes replace cumbersome braces or troubling opioids; it can also be soothing to rub the cream directly onto the area it hurts.

How compounded pain creams work

Compounded pain creams function by transporting pain-treating ingredients through the skin to tissues in the body that are hurting. 

They can contain unique blends of active ingredients:

  • Anesthetic (pain killing) creams may contain lidocaine, benzocaine, tetracaine or cannabinoids (CBD)
  • Inflammatory control creams may hold nonsteroidal anti-inflammatory drugs (NSAIDs) like diclofenac, ketoprofen or ibuprofen 
  • Creams to disrupt pain signaling pathways may include menthol, capsaicin, camphor or other ingredients that can induce tingling, cooling or burning sensations 
  • Muscle relaxant creams relieve some of the pain of muscle tension and may contain cyclobenzaprine or similar ingredients
  • Neuropathic pain creams use ingredients such as tricyclic antidepressants like amitriptyline
  • Arnica or cannabinoids (CBD) are popular additives to some pain creams as well

Creams also contain inactive ingredients that affect the cream’s thickness, shelf stability and smell. These can include:

  • Emollients, like canola oil or almond oil, that help transmit active ingredients through the skin
  • Suspension agents like agar or silica, which affect a cream’s spreadability 
  • Scents, such as lavender, rosemary, citrus or chamomile oils

Is a pain cream a good fit for you?

Compounded creams for chronic pain relief may be appropriate for patients with specific concerns or priorities. For example, some people struggle to swallow oral medications (especially those big “horse pills”!) Others simply prefer the feeling of applying the cream (the very act of rubbing a painful area can sometimes provide an additional measure of relief, after all).

Since creams can be compounded to specific formulations, they can let people address very specific needs. People may want a certain ingredient blend (such as diclofenac sodium mixed with capsaicin), which creams can enable. It’s also possible for people to vary the “dose” of cream by varying the amount of cream they rub on each day, depending on that day’s specific pain level, which adds flexibility. This can be an advantage in the case of conditions such as Swimmer’s shoulder, a crick in the neck, aching elbows or foot pain.

Creams can convey sensations oral medications can’t, such as the tingling, “burn,” or other cooling or heating feelings you may have already experienced if you’ve already used IcyHot, for example. These additional sensations can disrupt or “distract” your usual pain signaling pathways, adding extra tools to your pain treatment toolkit. As a final potential advantage, pain creams may possibly cut down on systematic side effects over time.

How can you get a compounded pain cream?

Not all compounded creams are created equally. Finding a pain cream that works for you starts with professional medical guidance. Factors influencing your cream’s formula can include the kind of pain you’re going through and the area of the body you’ll be rubbing the cream on (thicker skin areas may need more carrier ingredients in the cream to help transport the active ingredients to the right place, for example). To get a personal compounded pain cream:

  1. Schedule an appointment with a general practitioner or pain specialist to discuss your pain and see if a topical solution may be a good fit for you. In some cases, this could happen via a telehealth appointment. 
  2. Your doctor will determine what ingredients would likely give you the best pain relief and will write you a prescription for a compounded cream that includes those ingredients. Don’t forget to mention any allergies you may have!
  3. You may fill the prescription at your local pharmacy offering compounding services; you could also send the prescription to a compounding pharmacy online. Companies will list a way to contact them or form to use when you need to upload your prescription.

Regardless of whether you’re getting cream in person or online, check to see whether the company you’re considering is accredited, and if so, with whom. The Pharmacy Compounding Accreditation Board (PCAB) requires pharmacies registered with them to follow reputable guidelines, which can give you a heightened measure of confidence. 

You can also verify whether a Certificate of Analysis accompanies each ingredient to indicate quality testing, as per regulations. Ingredients should be pharmaceutical grade, rated United States Pharmacopeia (USP) or European Pharmacopeia (EU). Finally, you can read online reviews to ensure you’ll get a good product and supportive customer service; you can also ask whether the company’s pharmacists receive any special training in compounding.

In general, a high-quality pain cream will transparently list its main contents, will include detailed instructions for use, will be prescribed by a licensed, registered medical professional and will include FDA-approved ingredients.

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Compounded pain cream tips

Once it’s yours, few tips for getting the most out of your compounded cream include:

  • Make sure your skin is clean and in good condition before applying your cream. If your skin has been cut, scraped, burned or otherwise damaged, you’ll want to avoid applying cream there.
  • Use gloves to apply the cream if you’re concerned about accidentally getting cream in your eyes.
  • Give your cream enough time to fully absorb. Don’t put clothes on too quickly, or the cream may smear onto them. 
  • Don’t use heating pads with your compounded cream, as this might accelerate the active ingredient absorption rate too much.
  • Be careful about taking nonsteroidal anti-inflammatory drugs (NSAIDs) at the same time that you’re using a compounded cream, since you may unintentionally take too much.
  • Where you apply your compound cream matters. If you’re using it primarily for knee pain, for example, be careful about applying that cream in other areas, particularly in areas where the skin is thinner or more permeable, such as the face or groin. 
  • Talk to your doctor if you notice a drop-off in how well your compounded cream is working, or if you feel itchy or get rashes. The cream’s formula can often be adjusted to meet your developing needs.
  • Don’t share your cream with a friend, or vice versa, since these are personally formulated medications.

Can I find a good compounded pain cream at Clearing?

Clearing works with advanced pain management doctors to develop its own prescription compounded cream formulas; many of Clearing’s formulas incorporate lidocaine or doxepin. Clearing’s personalized treatment plans bolster the use of compounded pain cream with a full complement of other tools as well, including access to advanced pain specialists as well as nutraceuticals, CBD cream, and personalized home exercises (depending on your specific plan).

This article is for informational purposes only and does not constitute professional medical advice. Always seek the advice of your healthcare professional with any questions or concerns you may have regarding your individual needs and medical conditions.