Wound Care

No site on the human or animal body is exempt from possible injury. Wound healing is often a necessary event in recovery from trauma, and many of the earliest recorded medical texts such as the Edwin Smith papyrus2 (ca 1600 BC) and the Ebers papyrus3 (ca 1534 BC) contain formulations thought to promote wound healing and prevent infection.

In the mid-1900s, the availability of penicillin4 was an important triumph in the fight against infections that, when inadequately treated, were relentlessly fatal. The effective delivery of antibiotics and other medications to certain injury sites, however, has continued to challenge pharmacists and physicians. Now new vehicles using older “tried and true” medications for transdermal drug delivery enable the healing of persistent wounds that have not improved with prior treatment.

 

Compounded Wound Care Treatment Articles

Topical Phenytoin and Misoprostol for Wound Healing

Topical Phenytoin in Diabetic Foot Ulcers

http://care.diabetesjournals.org/content/14/10/909

 

Topical phenytoin treatment of stage II decubitus ulcers in the elderly.

http://www.ncbi.nlm.nih.gov/pubmed/11408983

 

Case Report: Topical Gel for the Treatment of a Refractory Leg Ulcer

http://www.leesilsby.com/wp-content/uploads/2012/05/Topical-Gel-for-the-Treatment-of-a-Refractory-Leg-Ulcer.pdf

Topical Misoprostol and Wound Healing in Rats

http://www.woundsresearch.com/article/8076

 

Skin Irritation

Numerous topical preparations containing cholestyramine or sucralfate (creams, adhesive pastes, enemas, suppositories) have been used for their protectant properties or for treatment of a variety of dermatologic and mucosal problems, including oral and esophageal ulcers, peristomal and perineal excoriation, decubitus ulcers, and radiation-induced rectal and vaginal ulcerations, and second and third degree burns.

Ann Pharmacother 1996 Sep;30(9):954-6
Cholestyramine ointment to treat buttocks rash and anal excoriation in an infant.
http://www.ncbi.nlm.nih.gov/pubmed/8876854?dopt=Abstract

 

Dis Colon Rectum 1987 Feb;30(2):106-7
Cholestyramine ointment in the treatment of perianal skin irritation following ileoanal anastomosis.
http://www.ncbi.nlm.nih.gov/pubmed/3803113?dopt=Abstract

Clin Exp Dermatol. 2000 Nov;25(8):584-8
Topical sucralfate in the management of peristomal skin disease: an open study.
http://www.ncbi.nlm.nih.gov/pubmed/11167966?dopt=Abstract

Burns. 2001 Aug;27(5):465-9
Topical use of sucralfate cream in second and third degree burns.
http://www.ncbi.nlm.nih.gov/pubmed/11451599?dopt=Abstract

 

Change “Topical Pain Management” to “Pain Management” and divide into appropriate headings below.

 

Compounded Topical Pain Treatment Articles

Topical Analgesic Overview

http://esciencecentral.org/journals/pain-management-therapy-the-benefits-of-compounded-transdermal-pain-medication-2329-9126.1000188.pdf

http://painmedicinenews.com/download/TopicalsPMN070813_WM.pdf

 

Compounded Oral Treatments for Chronic Pain Articles

Low Dose Naltrexone (LDN)

http://www.ncbi.nlm.nih.gov/pubmed/23359310

 

As reported at the 28th Annual Meeting of the American Academy of Pain Medicine (AAPM) in 2012:

Fibromyalgia Pain Reduced by Low-dose Naltrexone

Low-dose naltrexone (LDN) has been found to be an effective, highly tolerable, and inexpensive treatment for fibromyalgia, according to the results of a placebo-controlled, double-blind trial.1 In the new trial sponsored by the American Fibromyalgia Syndrome Association, Jarred Younger, PhD, and colleagues from Stanford University, Palo Alto, California, evaluated 30 women with fibromyalgia, completing 2 weeks of baseline measurements, 12 weeks of LDN treatment, 4 weeks of placebo, and 4 weeks of follow up.2

The primary outcome for all patients was daily pain, reported through patient symptom severity reports via handheld computer. At the end of the trial, patients reported a 43% reduction in pain during the LDN treatment when compared to the placebo treatment (33%). The only major side effects reported more frequently during the LDN phase of treatment were vivid dreams (37% in LDN vs 13% in placebo) and headache (16% in LDN vs 3% in placebo). During both treatment phases, patients reported similar tolerability (89.2 vs 89.4 out of 100).

This study was a follow-up to an a preliminary pilot study.2 As demonstrated in both trials, LDN can be beneficial in pain management for patients with fibromyalgia, with minimal side effects and a high degree of tolerance. Further study, however, is warranted.

References

  1. Younger J, McCue R, Noor N, Mackey S. Low-dose naltrexone reduces the symptoms of fibromyalgia: a double-blind and placebo-controlled crossover study. Pain Med. 2012;13(2):Abstract 251.
  2. Younger J, Mackey S. Fibromyalgia symptoms are reduced by low-dose naltrexone: a pilot study. Pain Med. 2009;10(4):663-672.

 

Migraine Treatment

Midrin®

If you or your patient have benefited from treatment with Midrin®, you’ll be happy to know that even though Midrin® is no longer commercially manufactured, we can compound a preparation containing isometheptene, acetaminophen, and dichloralphenazone.

A multicenter, double-blind, randomized, parallel-group study concluded that “several parameters suggest that isometheptene mucate, dichloralphenazone with acetaminophen may have a slight advantage compared with sumatriptan succinate in the early treatment of mild-to-moderate migraine.”

Headache. 2001 Apr;41(4):391-8.
Comparative study of a combination of isometheptene mucate, dichloralphenazone with acetaminophen and sumatriptan succinate in the treatment of migraine. Freitag FG et al.

http://www.ncbi.nlm.nih.gov/pubmed?term=11318886