Transdermal Pharmacologic Treatment of Peripheral Pain: An Alternative to Systemic Treatment Using Opioids, High Dose NSAIDs and Psychoactive Drugs-A Health Policy Review

Abstract

Background: The national crisis resulting from the wide-spread abuse of opioids and other psychoactive drugs and its relationship to the prescribing practices of physicians has led to governmental and public pressure for clinicians to consider alternative therapies to pain treatment. Unfortunately, while the need for alternatives is widely recognized, there is little consensus regarding the appropriate substitutes. Objectives: The authors challenge the current pain treatment paradigm and its focus on the systemic treatment of pain, in particular peripheral pain, by the oral administration of opioids, high dose NSAIDS, anti-convulsants, and psychotropic drugs. The authors report that patients suffering from acute and chronic peripheral pain have benefitted in the physician’s practice from the transdermal delivery of a combination of an anti-convulsant (gabapentin) and an anti-inflammatory (naproxen). Study Design: A narrative review Methods: Literature search was conducted. Results: In this report the authors summarize how patients suffering from acute and chronic peripheral pain have benefitted in the physician’s practice from the transdermal delivery of combination of an anti-convulsant (gabapentin) and an anti-inflammatory (naproxen) in a 10% to 5% ratio. This compounded transdermal combination drug therapy, in that ratio, is intended to target the pain at its source while avoiding the adverse systemic effects commonly associated with the oral administration of either drug. Conclusion(s): The authors urge clinicians to consider local targeted transdermal pharmacologic treatment for a multitude of peripheral pain conditions, before implementing a systemic approach. Also, they raise concern that the insurance industry and their Pharmacy Benefit Managers (PBMs) are interfering with the ability of prescribers to provide their patients with less dangerous and less expensive alternatives to opioids and other systemic drugs by automatically denying reimbursement claims for transdermal medications and imposing pre-textual and burdensome demands for Prior Authorization (PA). These unnecessary barriers to care interfere with the doctor-patient relationship and the physician’s solemn duty to “first do no harm.” They prevent the patient from receiving pain treatment that has the best chance to restore well-being and function while minimizing or avoiding the deleterious effects to body and mind resulting from the systemic delivery of opioids, high dose NSAIDs, or powerful psychoactive drugs.