Pain Management Compounding

Pain management is essential because, even when the underlying disease
process is stable, uncontrolled pain prevents patients from working productively,
enjoying recreation, or taking pleasure in their usual roles in the family
and society.
Chronic pain may have many contributing factors, and therefore
can be much more difficult to manage than acute pain, requiring customized
treatment protocols to meet the specific needs of each patient.

What is Pain?

pain-management-compoundingPain is the most frequent reason people seek medical attention. It is one of the most common symptoms of disease and can significantly interfere with a person’s quality of life. It includes a nociceptive (sensory) component, caused by stimulation of nerve fibers and an affective (emotional) component. Pain is usually transitory, but some painful conditions may persist for years. Sometimes pain arises in the absence of any detectable stimulus, damage, or disease.

Pain Pathways

Nociceptive Pain (tissue damage)

  • Nociceptors are the nerves which sense and respond to parts of the body which suffer from damage. They signal tissue irritation, impending injury, or actual injury. When activated, they transmit pain signals (via the peripheral nerves as well as the spinal cord) to the brain.
  • Somatic and visceral causes
  • The pain is typically localized, constant, and often with an aching or throbbing quality.
  • This type of pain tends to respond well to treatment with opioids.

Neuropathic Pain (nerve damage)

  • Pain caused by damage or dysfunction to neural pathway of the peripheral or central nervous system. Pain signals continue to be generated in the injured/damaged area long after it has healed.
  • The pain can be continuous or intermittent burning, shooting, or electrical shock qualities.
  • The pain may persist for months or years beyond the apparent healing of any damaged tissues.
  • This type of pain is frequently chronic, and tends to have a lesser response to treatment with opioids, but may respond well to other drugs.

pain-targets-compoundingImportance of Targeting Different Pathways

The pain therapy depends on the type of pain. The benefit of treating different pain pathways helps to treat pain where it hurts and to target and treat pain from all different mechanisms of action. In addition,

it allows for more consistent and reliable pain relief, reduces drug dosages, reduces side effects, and allows for more options to meet each patient’s specific treatment needs.

Treatment Goals

  • ACUTE PAIN: Diagnose the source and remove or block the pain until damage or injury is healed.
  • CHRONIC PAIN: Complete relief of this type of pain is rare. The more realistic goal is to decrease the level of pain to a tolerable level.

Optimal treatment may involve the use of medications that possess pain-relieving properties, including some antidepressants, anticonvulsants, antiarrhythmics, anesthetics, antiviral agents, and NMDA antagonists. By combining various agents that utilize different mechanisms to alter the sensation of pain, physicians have found that smaller concentrations of each medication can be used.

Click to read Transdermal Pain Cream Case Studies.

Transdermal creams and gels can be formulated to provide high, localconcentrations at the site of application (e.g., NSAIDs for joint pain),for trigger-point application (e.g., combinations of medications forneuropathic pain), or in a base that will allow systemic absorption. Studies suggest that there are limited restrictions on the type of drugthat 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 hepaticmetabolism; therefore, side effects associated with oral administration can often be avoided.

The following is a list of pain conditions for which we commonly compound medications:

  • Arthritis
  • Ankle Pain
  • Back Pain
  • Burning Foot Syndrome
  • Carpal Tunnel Syndrome
  • CRPS (Chronic Regional Pain Syndrome)
  • Diabetic Neuropathy
  • Fibromyalgia
  • Foot Pain
  • Gout
  • Head, Neck, and Facial Pain
  • Knee Pain
  • Migraines
  • Muscle Spasms
  • Myofacial pain
  • Neuropathic Pain
  • Post Herpetic Neuralgia
  • Shingles
  • Shoulder Pain
  • Tennis Elbow
  • TMJ/TMD
  • (Temporomandibular Disorders)

We work together with the prescribing physician and the patient to solve problems by customizing medications that meet the specific needs of each individual. Please contact our compounding pharmacist to discuss the appropriate dosage form, strength, and medication.