Pain can have many sensations such as neuropathy, inflammatory, burning or itching. Topical pain management was commonly referred to as transdermal pain therapy. We now refer to it as permeation-enhanced topical pain therapy (PETPT) because “transdermal” is now primarily associated with manufactured patches like fentanyl, not compounded creams or gels. Because we can get a large amount of active ingredients directly to the affected area in a permeation enhancing base, this is a major benefit to compounding and applying topically. Oral doses must be absorbed and then distributed systemically. Which results in a relatively low dose ultimately arriving at the affected site. The oral dose needed to achieve therapeutic activity at the affected site often manifests as unwanted side effects (gastric distress, sedation, hypotension, etc.). As a result, the use of topical pain medications using a permeation enhancing base may be considered a viable alternative to oral pain therapies in many patients. There are a multitude of studies to show the active pharmaceutical ingredients we use have merit and clinical relevance today. The best pain medication is the one that addresses your pain.