PAIN MANAGEMENT

Pain management is essential, even when the underlying disease is stable. Uncontrolled pain too often prevents patients from working productively, enjoying recreation, or taking pleasure family activities. Chronic pain may have a myriad of causes and perpetuating factors. Sometimes chronic pain is much more difficult to manage than acute pain, requiring a multidisciplinary approach and customized treatment protocols to meet the specific needs of each patient. Our pharmacists have found that optimal treatment may involve the use of medications that possess pain-relieving properties, including some antidepressants, anticonvulsants, antiarrhythmics, anesthetics, antiviral agents, and NMDA (N-methyl-D-asparate) antagonists. NMDA-receptor antagonists, such as dextromethorpphan and ketamin, can block pain transmission in dorsal horn spinal neurons, reduce nociception, and decrease tolerance to and the need for opioid analgesics. (Anesth Analg 2001 Mar; 92(3):739-44).

Topical and transdermal creams and gels can be formulated to provide high local concentrations at the site of application (e.g. NSAIDs for joint pain), for trigger point application (e.g. combinations of medications for neuropathic pain), or in a base that will allow systemic absorption. Side effects associated with oral administration can often be avoided when medications are used topically. Studies suggest that there are no serious restrictions on the type of drug that can be incorporated into a properly compounded transdermal gel. When medications are administered transdermally, they are not absorbed through the gastrointestinal system and do not undergo first-pass hepatic metabolism.

We work together with you and your doctor to solve problems by customizing medications so that they meet your specific needs. Please contact our compounding pharmacist to discuss the dosage form, strength, and combination that is most appropriate for the patient.