Iontophoresis and phonophoresis are drug delivery methods. They both involve medical devices and help topical medication absorb into your skin more effectively. Whereas iontophoresis uses electrical currents to do this, phonophoresis uses ultrasound waves to do it.

These methods appear most commonly in the physical therapy setting. Patients have benefited from iontophoresis to decrease pain, inflammation, and muscle spasms. In fact, it helps medications absorb into the skin up to 60 times more effectively than traditional topical medications. 

Phonophoresis has proven effective since the 1960s to treat sprains and strains in muscles, ligaments, and joints. Your physical therapist will apply a gel or cream corticosteroid or anesthetic to the site, then let ultrasound waves help your skin absorb it more effectively.

NSAIDs, or nonsteroidal anti-inflammatory drugs, have long helped patients with back aches, headaches, or arthritis. However, side effects often interfere with the ability of these drugs to work well.

Our team can compound topical NSAIDs that work directly on a painful or inflamed site while avoiding the side effects of oral doses. Although many patients prefer this delivery method, many patients have also found that different topical NSAIDs do not absorb with the same effectiveness. Causes for this can depend on the application site, the drug formulation, and the patient’s underlying condition (if any).

Affecting over 39 millions Americans, migraines can start as dull headaches that progress to severe headaches with nausea, vomiting, and light sensitivity. It is a neurological condition and can affect all ages.

One study found the effectiveness of intranasal (or in-the-nose) oxytocin for migraine patients. Other compounded medications can include (but are not limited to) ketamine gel, lidocaine/prilocaine gel, and ibuprofen suppositories.

Also called neuropathic itch, neuropathic pruritus is a severe itch that happens when your neurons fire incorrectly. It is also a complication of herpes zoster (or chickenpox).

Patients with neuropathic itch have found moderate relief with a compounded gel that includes amitriptyline (2%) and ketamine (0.5%).

Elderly patients experience more neuropathic pain conditions (and therefore more neuropathic pain) than do younger patients. The elderly also usually require lower dosing and more monitoring due to certain potential adverse effects.

Topical analgesics have shown the most promise for neuropathic pain among this demographic. Either in patch or gel form, lidocaine (5%), capsaicin (8%), and ketamine (1%) can offer patients relief with few adverse effects and a positive therapeutic outcome.

Herpes zoster reactivation, shingles, affects 0.2% of the population and postherpetic neuralgia (PHN) occurs in 10 -15% of patients following an episode of shingles, with the greatest risk in the elderly. A retrospective review involved 23 consecutive patients attending a tertiary complex pain clinic (University Hospital of Wales, Cardiff and Vale University Local Health Board), who were treated with topical gabapentin gel.

Multiple studies have already demonstrated the efficacy of oral gabapentin in treating chronic neuropathic pain, however efficacy is often limited by dose dependent toxicity. Although this patient population was small, these findings support the use of topical gabapentin in the treatment of PHN and potentially other painful neuropathy.

Neuropathic pain stems from injured or damaged nerves and can happen anywhere on your body. Patients have described the pain as a burning sensation, a zapping, or like pins and needles.

Topical clonidine (0.1%) has shown to provide moderate relief for neuropathic pain but also for hypertension and chronic pain. Clinical trials are ongoing, and the results have shown promise as an effective alternative to oral doses with adverse effects.

Patients, particularly those with peripheral neuropathy (or nerve pain extending to your limbs), have also enjoyed moderate relief with topical gabapentin (6%) and ketamine (10%).

Topical amitriptyline-ketamine combination is a promising agent for peripheral neuropathic pain conditions. Efficacy may depend on many factors, including the choice of vehicle, method of compounding, concentration, site of pain, and specific diseases.

Postherpetic neuralgia is nerve and skin pain that results from shingles (or herpes zoster) blisters and rashes. It can also continue after the shingles have gone away.

Intranasal ketamine solution (10%) and cream-form gabapentin (6%), ketoprofen (10%), lidocaine 5%, and ketamine (10%) have helped relieve this pain with no adverse effects.

Formerly called reflex sympathetic dystrophy (RSD), CRPS is a neuropathic pain syndrome that affects your arms or legs. The pain is also out of proportion to the initial injury that caused it.

Patients with CRPS have found relief with low-dose naltrexone (LDN). This low dose refers to doses about 50 times lower than doses of naltrexone typically given to patients addicted to opioids. Although it does not work right away, this medication can improve CRPS patients’ symptoms after months of use.