CRAMPS are mostly unpleasant painful sensations caused by muscle contraction or over-shortening. Common causes of skeletal muscle cramps may include muscle fatigue, low sodium, low potassium, and/or low magnesium. Smooth muscle cramps may be due to menstruation or gastroenteritis. Causes of cramping include hyperflexion, hypoxia, exposure to large changes in temperature, dehydration, or low blood salt and electrolytes.


POSTHERPETIC NEURALGIA (PHN) is a nerve pain due to damage caused by the Varicella Zoster Image result for POSTHERPETIC NEURALGIAVirus. Typically, the neuralgia is confined to a dermatomic area of the skin and follows an outbreak of herpes zoster (HZ, commonly known as Shingles). Neuralgia typically begins when the HZ vesicles have crusted over and begin to heal. Postherpetic neuralgia is thought to be nerve damage
caused by herpes zoster. The damage causes nerves in the affected area to send abnormal electrical signals to the brain which may convey excruciating pain and may persist or recur for long periods of time.


Rectal Pain

Anal Fissures

An Anal Fissure is a tiny tear causing a linear ulcer to form at the boundary of the anus. Anal fissures cause itching, pain, and bleeding. Anal fissures cause pain during bowel movements that can last for hours on end.They are caused sometimes by extreme constipation as well as diarrhea. If constipated, the passage of hardened and dry stool may cause some tearing on the anal lining. Fissures can also be caused during diarrhea by frequent wiping of the inflamed or swollen area of the anal canal. A diet rich in high fiber, combined with drinking 8-10 glasses of water every day, can help in promoting healthier bowel movements while curtailing further damage to anal tissue. Nifedipine 2%, Lidocaine 1.5%


Hemorrhoids can also cause rectal pain, itching, burning, and bleeding. Hemorrhoids are usually swollen veins found in the lower rectum and around the anal canal. Hemorrhoids are usually classified as internal or external. The usual causes of hemorrhoids can be constipation or diarrhea due to excessive straining and wiping during bowel movements. Hemorrhoid treatment usually includes over-the-counter ointments and creams, as well as suppositories. One can also use natural remedies available in oral and ointment forms which, when used together, can prove to be a moderately effective alternative.


GOUT (also known as Podagra when it involves the Big Toe) is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis – a red, tender, hot, swollen joint. The metatarsal-phalangeal joint at the base of the big toe is the most commonly affected (approximately 50% of cases). Gout is also found in joints of fingers. It is primarily caused by elevated levels of Uric Acid in the blood. The uric acid crystallizes, forming needle-like crystalline structures in joints, tendons, and surrounding tissues.


Pain Management is essential because even when the underlying process is stable, uncontrolled pain prevents patients from working productively or enjoying the normal rhythm of life. Pain disruption can affect sleep, concentration, induce drowsiness, and much more. Chronic pain may have a range of causative factors and therefore can be much more difficult to manage than acute pain, requiring multiple approaches and customized treatment protocols to meet the specific needs of each patient.

Optimal treatment may involve the use of medications that possess pain-relieving properties, including antidepressants, anticonvulsants, antiarrhythmics, anesthetics, antiviral agents, and NMDA (N-methyl-D-aspartate) antagonists. NMDA antagonists, such as Amantadine and Ketamine, can block pain transmission in dorsal horn spinal neurons, reduce nociception, and may decrease the need for opioids.

By combining various agents which utilize different mechanisms to alter the sensation of pain, commonly smaller concentrations of each medication can be used. Topical and transdermal creams and gels can be compounded and formulated to provide high local concentrations at the site of application. Side effects associated with oral administration can often be avoided when medications are used topically. These side effects from oral pain medications may include: GI irritation, liver damage, kidney problems, drowsiness, constipation, and more. Over 56,000 emergency room visits are made each year just from over-the-counter oral pain remedies. Studies suggest that there are no great restrictions on the type of drug that can be incorporated into a properly compounded product.

When medications are administered transdermally, they are not absorbed through the gastrointestinal system and do not undergo first-pass hepatic metabolism, which can greatly reduce certain drug interactions and negative side effects. Using a topical makes application easy and controllable as well as onset of relief may be seen faster than oral preparations. Formulations penetrate through the skin to produce effects in the tissues underneath while avoiding many systemic side effects.