Topical Pain Relief in Older Adults: How Compounded Formulations Are Advancing Personalized Pain Management

When Pain Relief Needs a More Targeted Approach

Pain is one of the most common health challenges affecting older adults. Conditions such as osteoarthritis, peripheral neuropathy, and chronic musculoskeletal disorders can significantly impact mobility, independence, and overall quality of life.

Traditionally, pain management has relied heavily on oral medications. While these treatments remain an important option for many patients, older adults may face additional challenges due to age-related changes in drug metabolism, multiple medications, and increased sensitivity to adverse effects.

As healthcare continues to move toward more personalized approaches, topical pain formulations have gained interest as a way to deliver therapy directly to areas of discomfort while potentially reducing systemic medication exposure.

Rather than treating pain throughout the entire body, topical therapies aim to provide localized relief where it is needed most.

Why Topical Pain Formulations Are Especially Relevant for Older Adults

Managing pain in older adults can be complex because many patients experience multiple chronic conditions simultaneously. A person living with osteoarthritis may also experience neuropathy, reduced mobility, or other age-related health concerns, making a personalized approach increasingly important.

Systemic pain medications, while effective, may present additional challenges in elderly populations. Changes in kidney and liver function, increased medication use, and greater sensitivity to certain medications can influence treatment tolerability.

Potential concerns associated with systemic pain medications include:

• Gastrointestinal risks associated with long-term NSAID use
• Sedation and dizziness associated with certain analgesics
• Increased fall risk related to medications affecting the central nervous system

Topical formulations provide an alternative approach by focusing treatment on the affected area. Applying medication directly to a painful joint, localized nerve region, or treatment site may help target symptoms while reducing unnecessary systemic exposure.

Common conditions where topical pain therapies may be considered include:

• Osteoarthritis-related joint pain
• Peripheral neuropathy
• Post-herpetic neuralgia
• Localized muscle and soft tissue pain
• Procedure-related discomfort
• Chronic wound-related pain

However, topical therapy is not appropriate for every type of pain. Treatment selection depends on the underlying cause, severity, and individual patient factors.

The Role of Pharmacy Compounding in Personalized Pain Management

The growing interest in personalized topical pain management has highlighted the importance of not only selecting the appropriate active pharmaceutical ingredients (APIs), but also choosing a delivery system that can effectively incorporate and support those ingredients.

Neuropathic pain formulations often involve multiple therapeutic approaches because nerve-related pain can involve several overlapping pathways. Compounded preparations may combine ingredients such as gabapentin, amitriptyline, ketamine, and lidocaine to create customized formulations based on individual patient needs.

Pharmacy compounding provides an opportunity to customize formulations based on specific patient needs, including:

• Active ingredient selection
• Medication strength
• Dosage form
• Vehicle or base selection

For example, a patient experiencing localized neuropathic pain may benefit from ingredients that target nerve signaling, while a patient with osteoarthritis may require an anti-inflammatory approach.

This flexibility is particularly valuable for elderly patients, where treatment goals often include maintaining mobility, improving daily function, and minimizing medication-related complications.

Compounded Topical Formulations for Neuropathic Pain

Not all pain originates from inflammation or tissue injury. Neuropathic pain occurs when nerves become damaged or sensitized, producing symptoms such as:

• Burning sensations
• Tingling
• Numbness
• Electric shock-like pain
• Increased sensitivity to touch

NOVODURE™ is designed to support the development of personalized topical preparations by providing a versatile platform for incorporating commonly used pharmaceutical ingredients in compounded formulations.

Ketamine

Ketamine acts on NMDA receptors involved in pain sensitization pathways. Topical ketamine formulations have been explored for neuropathic pain conditions, including:

• Complex regional pain syndrome (CRPS)
• Peripheral nerve injury
• Chronic localized nerve pain

The goal of topical delivery is to target local pain pathways while limiting systemic exposure associated with oral administration.

Typical formulations prescribed:

• Ketamine 10% + Gabapentin 5% + Lidocaine 5%
• Ketamine 10% + Ketoprofen 10% + Gabapentin 5% + Clonidine 0.2%

Lidocaine

Lidocaine is one of the most commonly used topical anesthetic ingredients in pain management formulations.

By blocking voltage-gated sodium channels involved in nerve transmission, lidocaine can reduce localized pain signaling and help decrease sensitivity in targeted areas.

In compounded topical formulations, lidocaine may be prescribed alone or combined with other active pharmaceutical ingredients to support a multimodal approach to pain management. These combinations may include non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, or neuropathic pain medications such as gabapentin, depending on the patient’s specific condition and treatment goals.

Potential applications include:

• Peripheral neuropathy
• Scar-related nerve discomfort
• Localized sensitivity
• Musculoskeletal pain with inflammatory components

Typical formulations prescribed:

• Diclofenac 5% + Lidocaine 2%
• Ketoprofen 10% + Lidocaine 2%

Ketoprofen

Ketoprofen is a non-steroidal anti-inflammatory drug (NSAID) commonly used for managing pain and inflammation associated with musculoskeletal conditions.

By inhibiting cyclooxygenase (COX) enzymes involved in prostaglandin production, ketoprofen can help reduce inflammatory signaling that contributes to localized pain and swelling.

In compounded topical preparations, ketoprofen may be incorporated into creams, gels, or other topical dosage forms to deliver targeted anti-inflammatory effects at the site of discomfort.

This approach may be beneficial for patients experiencing localized pain or inflammation associated with conditions such as:

• Osteoarthritis and joint-related pain
• Tendon and ligament injuries
• Muscle soreness or strain
• Localized inflammatory pain

Typical formulations prescribed:

• Ketoprofen 10% + Gabapentin 5%
• Ketoprofen 10% + Menthol 0.5%

Topical Anti-Inflammatory Formulations for Joint and Musculoskeletal Pain

Osteoarthritis is one of the most common causes of chronic pain among older adults, frequently affecting the knees, hands, hips, and other joints.

As cartilage gradually breaks down and inflammation develops around affected joints, patients may experience pain, stiffness, and reduced mobility.

Topical anti-inflammatory medications, particularly diclofenac-based formulations, are commonly used for localized osteoarthritis pain.

By reducing inflammatory pathways involved in pain signaling, topical NSAIDs may help improve:

• Joint comfort
• Mobility
• Daily function

Compared with oral NSAIDs, topical approaches may reduce overall systemic exposure, which is an important consideration for older adults who may have increased risk of gastrointestinal, cardiovascular, or kidney-related complications.

Compounding may provide additional flexibility by allowing customization of formulation strength, vehicle characteristics, or combination with other ingredients such as local anesthetics.

Typical formulations prescribed:

• Diclofenac — A commonly used topical NSAID for localized osteoarthritis and musculoskeletal pain. It may be formulated alone or combined with other ingredients to support anti-inflammatory and analgesic effects.
• Ketoprofen — Another NSAID option used in compounded topical preparations to help reduce localized inflammation and pain associated with joints, tendons, and soft tissues.
• Diclofenac + Lidocaine — A combination approach that pairs an anti-inflammatory agent with a local anesthetic to address both inflammatory pain and localized sensitivity.
• NSAID combinations with supportive ingredients — Depending on patient needs, compounded formulations may incorporate additional ingredients designed to improve comfort, support penetration, or target multiple pain pathways.

Beyond the Active Ingredient: The Role of Topical Delivery Systems

The effectiveness of a topical pain formulation depends not only on the active ingredient, but also on how effectively that ingredient is delivered through the skin.

The skin acts as a protective barrier, which can limit medication movement into targeted areas. For compounded formulations, the choice of base or vehicle plays an important role in factors such as drug incorporation, spreadability, consistency, and patient experience.

Advanced delivery systems are being explored to improve formulation performance while maintaining ease of use and patient comfort.

NOVODURE™ is an advanced compounding platform designed to support personalized topical formulations through nano-dermal delivery technology. Powered by multi-layered NLV (Nano Lipid Vesicle) technology, NOVODURE™ is designed to support the delivery of a range of active pharmaceutical ingredients, including NSAIDs such as diclofenac and ketoprofen, neuro-analgesics such as gabapentin, and analgesic agents such as ketamine. Its advanced lipid-based structure enables high API loading capacity while supporting rapid and sustained topical delivery, offering pharmacists a flexible foundation for developing customized pain management formulations.

The Future of Personalized Topical Pain Management

Pain is complex, and two patients with the same diagnosis may experience different symptoms and treatment responses.

The future of topical pain management will likely involve combining:

• Targeted active ingredients
• Personalized formulations
• Advanced delivery systems
• Patient-centered dosage forms

For older adults, these innovations may provide new opportunities to improve comfort, maintain mobility, and support independence while reducing reliance on therapies that may carry greater systemic risks.

As pharmaceutical technology continues to evolve, topical formulations are becoming more than simple creams. They are becoming personalized delivery systems designed around the unique needs of each patient.

Topical pain formulations represent an important area of innovation in modern pain management, particularly for patients who require localized therapy with reduced systemic exposure.

From BLT formulations used for procedural anesthesia to compounded preparations containing lidocaine, ketamine, gabapentin, or anti-inflammatory agents, pharmacy compounding allows healthcare providers to develop customized solutions for a wide range of pain conditions.

The next generation of topical therapies will focus not only on selecting the right active ingredient, but also on optimizing how that ingredient is delivered. Through advances in compounding technology and delivery systems, personalized topical formulations may continue to expand the possibilities for safer and more effective pain management.

References

1. National Association of Pharmacy Regulatory Authorities (NAPRA). Guidance Document for Pharmacy Compounding of Non-sterile Preparations.
   NAPRA guidance document
2. National Academies of Sciences, Engineering, and Medicine. Compounded Topical Pain Creams: Review of Safety and Effectiveness of Select Ingredients. Washington, DC: National Academies Press; 2020.
   https://doi.org/10.17226/25689
3. Hollander JE, et al. Comparative Study of Compounded Anesthetic Benzocaine/Lidocaine/Tetracaine (BLT) Cream with and without Abrasive Particles. Journal of Clinical and Aesthetic Dermatology. 2017.
   PMC article
4. ClinicalTrials.gov. Comparison of Compounded Topical Anesthetics: BLT vs Lidocaine for IPL, PDL, and Microneedling Procedures (NCT06569537).
   ClinicalTrials.gov record
5. Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. The Lancet Neurology. 2015;14(2):162–173.
6. Derry S, Wiffen PJ, Kalso EA, Bell RF, Aldington D, Phillips T, et al. Topical NSAIDs for chronic musculoskeletal pain in adults. Cochrane Database of Systematic Reviews. 2016.
7. Derry S, Rice ASC, Cole P, Tan T, Moore RA. Topical lidocaine for neuropathic pain in adults. Cochrane Database of Systematic Reviews. 2014.
8. Wiffen PJ, Derry S, Bell RF, Rice ASC, Tölle TR, Phillips T, et al. Gabapentin for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews. 2017.
9. Williams AC, Barry BW. Penetration enhancers. Advanced Drug Delivery Reviews. 2012;64(Suppl):128–137.
10. Patel A, et al. Nanoemulsion-based drug delivery systems for topical and transdermal applications. Journal of Controlled Release. 2020;321:468–486.