After a month of making a nuisance of myself I finally convinced my Rheumatoligist to write a prescription for a 20% ketoprofen topical. I picked it up today and I am a little disappointed. I was expecting a topical that I could apply to the whole of my right knee to keep the inflammation down so the knee could heal. This is about 190 square inches of skin to cover to encompass the knee from top to bottom where all the inflammation is visible. What I got was a prescription that said to use 2-6 drops three times a day, with 6 drops only covering a small corner of my knee. It is almost as if the prescription was written to counter mild, localized arthritic pain rather than reduce the inflammation of a large joint.

I think I will call the compounding pharmacy tomorrow and explain the situation to them.

I know Sue22 often talks about KIP gel and others on this board have had compounding NSAID gels made as well. Are all of your prescriptions written up the same way as mine? If I follow the instructions I will be using less NSAID then I was using the Voltaren cream and the idea was to increase the intensity of the treatment rather than reduce it. Yes I did the math and I was using about 8 grams of diclofenic a month and this prescription only contains 6 grams of ketoprofen which is equal to about 4 grams of diclofenic in strength.

I have two compounding gel's that my Dr. gave me plus she gives me the Volteren gel as well and the Lidoderm and Flector patches for larger area's. I have found the Flector patches to be useless.

For fingers, knees, elbows, toes and smaller places, the Volatren gel Wins!

The compounding gels are 1]Cascade Diclofenac 2]Baclofen 3]Cyclobenzoprene 4]Gabepentin 5]Tetracaine 3/2/2/2%. The other compouded one has the same ingredients but has one extra-1]Diclofenac 2]Baclofen 3]Clyclobenzoprene 4]Gabapentin 5]Tetracaine 3/2/2/6/2%.

i don't use the KIP gel often, mostly when my spine / neck is flared as its hard to use anything else there. I just use as much as I need to, within reason of course, i just use an amount that covers the surface i need to cover and rubs in. the directions pretty much say to do that. it does help when i need it.

i always found the topical voltaren, premade prescription to be too weak for anything other than using it with the ultrasound.

i still find ice to be the best, its just less convenient.

Pea:

the only way my flector patch works is to use the entire thing over my SI joint and keep it there 24/7 except to shower / bathe, then i just put it back on, and i change it every 12 hours, just like taking a pill. then and only then does it work pretty well, most of the time.

but also, it does not work when i'm in a flare. it has to be a only a moderate amount of inflammation. too much overrides it.

but i do have to just keep it there continually as well.

thus i don't think it would work well if it were moved around. then i think the topical gels are better. IMO.

the blue icy gel has its place too.

and my ultrasound machine has its place, just not over the spine or other boney areas. but great on enthesitis and soft tissue stuff.

I managed to get a hold of the pharmacist at the compounding pharmacy on Saturday. After talking to him we agreed that the prescription had been filled incorrectly. What I was given was a formulation for managing spot pain when what I needed was a topical for applying to a large inflammation area. They have a formulation for that purpose and it sounds like I was given the wrong topical as my rhuematologist did not make it clear the purpose of the prescription.

I will be picking up the new prescription Monday after work. I will see then how well it works. Sadly the kenilog shot has already largely worn off. The idea was to have an anti-inflammatory topical before the shot wore off, but that didn't happen.

I have used the Flector patches like that too but no go. I feel more relief from the Lidoderm patches but since I am now on the wonderful fentanyl patch, I only have to use a Lidoderm, cut up on one spot on my neck bone.

Yes, Ice works but when you are in the car it's hard to get around like that. That's why I like my gel's. All three of them but not at the same time. I have others on them now from their doc's and they love them.

I think I asked you before but with fibro fog forgive me if I did. Have you had Rhizotomies there? Easy solution.

hope that new formulation works for you!

sorry the shot is already wearing off.

hi pea,

not altogether surprised about the flector patches. maybe your inflammation is just to great for them. i know mine only works if the inflammation is low level in-between-flare inflammation; more than that and it doesn't work.

funny how different we all are, as those lidocaine patches did diddley for me.

as for the rhizotomies, i've thought about them, and may still get them; my interventionalist does do them. the cortisone injection there helped but too short term. the few sets of triggerpoints in my upper back / shoulder / neck region has helped a lot; they did in the past, so think it was simply time for more. but if i need the rhizotomies, i'll consider. my chiro doesn't like them, as one of the major philosophies of chiro is how important the nerves are, but he's also a good guy and said that i should make the decision for myself, but did tell me what he didn't like about them. its good to have both sides to an argument; more informed decisions can be made that way.

as for the driving around. yeh, driving on ice, not the most convenient thing in the world. but interestingly, if i use one of those big rectangular gel ice packs when i drive, then both my upper back and neck are good so long as not in a major flare. driving between home and work is ok cause i have a good freezer in both places. and the chiro will put my ice pack in his freezer as well. everywhere else and i have to pack a cooler full of ice packs for the "trip", but if its just one or two places and just for a few hours, it works. but anything more or longer and i can't do it.

i know you, possi, rumble have had good luck with rhizotomies, so it will probably happen down the road, for the neck and maybe eventually even for the SI. for now, i'm managing for the most part.

I have had the new topical formulation for a couple of days now and I am happy with it so far. I have managed to get the inflammation down to the point where both knees match. Something I haven't seen in over a year. The effect is temporary however and the inflammation does fluctuate but it is consistently reduced.

The bad news is the compounded cream is too pricey for me to use as intended. The idea was to keep the inflammation suppressed long enough to allow the knee to heal. With at least 150 square inches of skin to cover, a 60g tube does not last long. The compounding pharmacy I used is charging over a $1 per gram for their cream regardless the concentration or variety of the NSAID so I cannot afford to cover the inflammation area with cream 3-4 times a day until the knee heals like I had planned.

This is more good news than bad news however. Now that it appears that a topical NSAIDs will work if at the right strength and concentration, I just need to find a way of getting the medication in a way that will fit my budget. Maybe there is a compounding pharmacy out on the internet that will fill a prescription or some other source I can get something similar within budget.

Skip's Pharmacy is one I see online for compounding the LDN. I use my local compounding pharmacy, but if Skip's is cheap for LDN, then maybe......

and if all else fails, if its just to heal it up for a few days, ice, while inconvenient, is cheap!