Pikes Peak Hospice and Palliative Care, Inc., provides care for more than 200 patients with terminal disease who reside at home, in long-term care facilities, in assisted living facilities, or in its acute-care Inpatient Unit. Over the past 4 years, its pharmacy has evolved to provide individualized compounded preparations to meet the unique and complex needs of these patients. An integral part of this evolution was development and implementation of topical treatment for pain. These patients often have multiple medical conditions and complicated health issues. Nearly 50% of patients in the care of Pikes Peak Hospice receive a topical compound to treat any of a variety of conditions, including neuropathies, muscle skeletal pain, wound pain, agitation, and anxiety. Topical compounds give practitioners another option in managing patient maladies and, in many instances, compounded topicals have proven as effective, if not more effective, than commercially available products. In some cases, patients have been able to stop oral pain medications or reduce their dose because the topical preparation is so effective. All in all, the topical preparations described in this article have been invaluable to our patients' comfort and an indispensable option for practitioners.