Compounding Pharmacists Key Resources for Patients Needing Relief from Chronic Back Pain

Compounding Pharmacists Key Resources for Patients Needing Relief from Chronic Back Pain

i-bottleAbout 80 percent of those with back pain will see improvement after 12 weeks of treatment, but they’re not out of the woods. One-third will continue to suffer for at least a year and for many, the chronic pain becomes an ongoing fact of life. Community pharmacies are often the first place patients visit, seeking over-the-counter treatments, then they come back time and time again as they fail to find sufficient relief. Compounding pharmacists who choose to connect with them can make an impact. It’s important that patients know that exercise improves chronic back pain and compounded topical treatments support that goal.

Current State of Pharmaceutical Treatment for Chronic Back Pain

The news isn’t good for patients with chronic back pain, with strengthened warnings about NSAIDs and studies reporting that first-line pharmaceutical treatments may lack efficacy. A systematic review published in March 2015 found that acetaminophen did not reduce pain intensity or improve quality of life.1 Another study showed that combining naproxen with cyclobenzaprine or oxycodone and acetaminophen didn’t improve pain relief.2 Of course, these results won’t hold true for everyone and patients will still take these medications, but they may offer some answers for patients who aren’t finding the relief they need.

The interesting thing about using opioids for chronic back pain is that they don’t provide the level of relief you would expect. A systematic review found that subjects only achieved moderate pain relief at most and reported little improvement in function.3 Only one study in the review compared opioids to something other than a placebo. While tramadol reduced pain better than celecoxib, there was evidence of bias and a significant drop-out rate that may have skewed the results. In fact, all of the studies provided very low to moderate quality evidence. For example, none of the five randomized controlled trials that looked at tramadol versus placebo documented the number of subjects receiving concurrent treatment or the type of treatment.

Compounded Topical Treatments Support Chronic Back Pain Relief

Conservative treatment for back pain includes acetaminophen or NSAIDs and application of heat or ice. Exercise is an increasingly important component of the treatment plan. It reduces the risk of recurrent episodes of lower back pain by 35 percent—or 45 percent when combined with education.4 In an editorial in JAMA Internal Medicine, Timothy S. Carey, MD, MPH and Janet K. Freburger, PhD, of the University of North Carolina at Chapel Hill, wrote, “If a medication or injection were available that reduced lower back pain recurrence by such an amount, we would be reading the marketing materials in our journals and viewing them on television.” They also noted that formal exercise instruction is not commonly prescribed.

This is where compounding pharmacists can make a difference. Topical applications that relax muscles and keep pain at bay make it easier for patients to stick with their exercise regimen and to stay engaged in their normal daily activities. Compounded solutions are optimal, as medications are combined and dosed to target the individual’s level of pain, but many patients opt for over-the-counter products simply because they’re not aware they have better options such as:

  • Specially formulated delivery bases that boost epidermal penetration to give more relief.
  • Ability to mix several analgesics to target multiple pain sensors or to include muscle relaxants, whether with convenient pre-packaged pharmaceuticals that combine methyl salicylate, menthol and capsaicin or bulk APIs.
  • Patients may be familiar with lidocaine and capsaicin as the active ingredients in OTC products, so let them know you can compound the same ingredients in a more effective dose.
  • Counsel patients about topical NSAIDs. Be sure they know that topical treatment offers pain relief without the risk of systemic side effects.
  • If your patients take opioids, urge them to talk with their doctor about switching to transdermal buprenorphine, which can deliver pain relief while weaning them from oral opioids.

Connect with Patients with Chronic Back Pain Through Targeted Outreach

In order to promote your patient’s health and build your customer base, you may need to develop an outreach plan that’s more extensive than your current efforts. While this takes a little time up front, after you have a plan in place—and you’ve trained your staff so they know who to target and what to say—it becomes a normal operating procedure. Here are a few tips to get you started:

  • Offer medication management and review. Every time a patient fills a prescription, make sure they’re told about free medication management. Have a pamphlet or print-out to give them with info about how they can benefit from talking with the pharmacist. It’s important to do more than ask whether they have questions or need to talk with the pharmacist, as this doesn’t inform them about the value of an appointment to review medication.
  • If the patient hasn’t been to the doctor, it’s essential to assess whether the pain is acute or chronic and refer them to their physician or ER if the pain is due to trauma or they complain of fever, numbness, weakness, tingling or incontinence.
  • As you reach out to patients, ask whether they exercise to strengthen core muscles. If not, suggest they consult their doctor or a physical therapist for guidance.
  • Ask whether they have trouble sleeping due to pain, which opens the door to compounding natural sleep aids.
  • Place informational posters at the cash register or near OTC products that simply ask whether the patient has back pain, alert them to compounded solutions, and suggest they take advantage of a consultation with the pharmacist.
  • Train staff to notice when patients buy topical OTC products for back and muscle pain. Provide them with a handout covering back pain info, the benefits of compounding and the availability of consultations—don’t sneak it into their bag; bring it to their attention.
  • Dedicate space in the pharmacy as a back pain information center. Offer info with local resources and alternative treatments like low-dose tricyclic antidepressants, acupuncture, massage and talk therapies that help relieve pain.5 This is also an opportunity to sell supplemental products, such as protein powder or individual amino acids that help boost serotonin, GABA and endorphins.6

Improve Quality of Life for Patients and Build Your Business

Patients with chronic back pain—an estimated 29 percent of all adults—need help they may not be getting from other health care professionals. Compounding pharmacists are obviously important for all the usual medications prescribed for this group, but you also have a significant opportunity to improve their life and build your business by providing topical relief for chronic back pain and promoting exercise.

Pharmaceutica North America provides the diverse pharmaceuticals you need for patients with back pain. Please contact us today to talk about our bulk API and premixed NSAIDs, muscle relaxants, sleep aids and other products that support your pharmacy.

Show 6 footnotes

  1. “Efficacy and Safety of Paracetamol for Spinal Pain and Osteoarthritis: Systematic Review and Meta-Analysis of Randomised Placebo Controlled Trials,” March 2015,
  2. “Naproxen with Cyclobenzaprine, Oxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain,” October 2015,
  3. “Opioids Compared with Placebo or Other Treatments for Chronic Low Back Pain,” April 2014,
  4. “Exercise Rx Plus Education Alleviates Lower Back Pain,” January 2016,
  5. “New Form of Talking Therapy Shows Promise for People Suffering From Chronic Low Back Pain,” June 2015,
  6. “Amino Acids and Diet in Chronic Pain Management,” January 2012,

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